Том 9, брой 2 - 2013/ Vol. 9, No. 2 - 2013

A. R. Massaro

W. Xu
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences – Beijing, China

Objective: We aim to investigate the feasibility of real-time TCD-EEG monitoring in patients with paroxysmal neurological diseases.

Design and Methods: This is an on-going single-center observational study. Six hours Real-time TCD-EEG (Delica NSD-8100) is performed in pre-surgical patients with refractory epilepsy and pre-surgical patients with Moyamoya disease and transient ischemic attacks. The TCD-EEG monitoring includes 10-20 system 16 channels EEG and bilateral middle cerebral artery blood flow velocity (CBFV) monitoring. To further investigate TCD value in the localization of epileptogenic focus, SPECT is performed, if available, in patients with seizure attacks for comparative analysis. To induce transient ischemic attacks, 3 minutes hyperventilation is performed in patients with Moyamoya disease.

E. Titianova
Clinic of Functional Diagnostics of Nervous System, Military Medical Academy – Sofia, Medical Faculty of Sofia University St. Kl. Ohridski – Sofia, Bulgaria

Objective: Space-time ultrasound application in adult Neurology is limited and not well investigated. The presentation aims to demonstrate its diagnostic abilities in clinical settings.

Material and Methods: Patients with carotid pathology, neuro-ophthalmic syndromes, neuropathy, myopathy, cervical tumors, calf muscle trauma and chronic spastic paralysis were studied by multimodal 2D/3D/4D sonography. The results were compared to the findings from other diagnostic methods.

M. Siebler
Mediclin /Essen Kettwig, Department of Neurorehabilitation/ University of Duesseldorf – Essen, Germany

Objective: By means of ultrasound (US) methods structural and functional properties of the muscle tissue could be detected in patients in real time and non-invasively. Using tissue velocity imaging (TVI) we are able to investigate the dynamics of movements in identified muscles. We tested whether this method could be applicated to measure the forearm muscle motions in order to monitor rehabilitation therapies and pharmacological effects.

Material and Methods: The voluntary movement of hand opening (M.ext. digitorum) and closing (M.flexor digitorum) was analyzed in healthy subjects (n=30) and stroke patients (n= 31) using the B-mode and tissue velocity imaging (TVI). TVI is based on the Doppler effect to record slow movements of the tissue and was adapted on a 6-8 MHz probe. We recorded synergistic contractions or dephasing (non-synchronous muscle activity) and quantified velocity of contraction and relaxation as well as there repetition frequency.

U. Walter
University of Rostock, Department of Neurology – Rostock, Germany

Botulinum neurotoxin (BoNT) injection has been increasingly used for treating muscular spasticity and dystonia. Unlike other techniques of precision targeting such as electromyography or computed tomography that have been described to minimize undesirable BoNT effects, B-mode ultrasound allows immediate and high-resolution imaging of the injection needle position within the target region. Visual identification of muscles and depth control of needle placement are the key features of ultrasound-guided injection that lead to improved targeting and safety of BoNT injections. Ultrasound may be helpful to validate already established injection techniques or when learning the correct injection technique. Ultrasound-guided BoNT injection has been recommended as a standard procedure in treatment of lower leg spasticity in children with cerebral palsy.

N. Takamatsu 1, H. Nodera 1, Y. Terasawa 1, A. Mori 1, M. Oda 2, Y. Izumi 1,2, R. Kaji 1
1 Tokushima University Hospital – Tokushima, Japan,
2 Vihara Hananosato Hospital – Miyoshi, Japan

Objective: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease mainly affecting the upper and lower motor neurons. Because reinnervation may preserve muscle strength and a motor action potential in its early stage, a sensitive measure to reflect the axon loss is needed for early diagnosis and follow-up. The aim of the study was to assess the degeneration of the nerve roots in ALS by ultrasonography.

Material and Methods: Twenty-four patients (16 men, 60±11 years) who met the diagnostic criteria of ALS (Awaji criteria) and 20 normal control individuals (10 men, 50±8 years) received sonographic evaluation of the C6 root (more symptomatic side for ALS, left side for control). A cross-sectional area was evaluated and compared.

E. Vicenzini 1, P. Pulitano 1, R. Cicchetti 2, P. Papov 2, G. Spadetta 3, M. Rocco 3, V. Di Piero 1, G. L. Lenzi 1, O. Mecarelli 1
1 Department of Neurology and Psychiatry,
2 Neonatal Intensive Care Unit,
3 Transplant Coordinator, Intensive Care Unit. Sapienza, University of Rome – Rome, Italy

Objective: Transcranial Doppler is sensitive technique for the diagnosis of cerebral circulatory arrest in brain death, when specific patterns such as reverberant flow and short systolic spikes are observed in intracranial arteries. These patterns are related to the occurrence of brain swelling in the inextensible skull, resulting in transformation from a normal “low-resistance” into a “high-resistance” brain parenchyma. In infants, the non-ossified fontanelles initially compensates for intracranial hypertension. We describe TCD patterns in infants with brain death, different from adults, with the hemodynamic modifications induced by anterior fontanelle compression.

U. Walter
University of Rostock, Department of Neurology – Rostock, Germany

Transcranial B-mode sonography (TCS) is a non-invasive, low-cost, short-duration neuroimaging method that allows high-resolution imaging of deep brain structures in patients with inflammatory and degenerative brain diseases. Hyperechogenicity of the substantia nigra (SN), a TCS findings present in about 90% of patients with idiopathic Parkinson's disease (PD), is already present in presymptomatic disease stages. SN hyperechogenicity has been demonstrated to correlate with iron accumulation in a number of brain disorders but also with microglia activation.

J. Valdueza
Neurological Center, Segeberger Kliniken – Bad Segeberg, Germany

The cerebral venous outflow has been neglected for many years in neurology. Considering Neurosonology a first interest started with primarily venous disorders, e.g. cerebral venous and sinus thrombosis. In the last few years venous ultrasound analysis was performed in a variety of other neurological disorders like dural fistulas, transient global amnesia and even in acute arterial stroke. In multiple sclerosis a chronic impaired cerebral venous outflow has claimed to be the starting point of a cascade leading to the disease. This concept has not been reproduced by groups with a longstanding experience in venous duplex sonography. However, the debates increased the scientific interest on the venous side of the cerebral circulation and its outflow.

H. Mitsumura 1, T. Nomura 2, H. Shiba 2, Y. Yoshimori 2, J. Kubota 2, M. Hashimoto 3, H. Furuhata 2
1 Department of Neurology, The Jikei University School of Medicine – Tokyo, Japan,
2 ME Laboratory, The Jikei University School of Medicine – Tokyo, Japan,
3 Hashimoto Electronic Industry CO., LTD – Matsusaka, Japan

Objective: Transcranial Doppler (TCD) is useful for detection of micro embolic signal (MES), however, it is insufficient for Japanese patients without temporal bone window. So we developed a novel probe attached to the cervix for detection of MES at carotid artery which can be evaluated in almost all of the patients. Our purpose of this study is to evaluate clinical availability of this probe.

Methods: Novel probe was 2MHz which had equal property with TCD, and the shape of probe was thin and square modified for attachment to the neck. 1) We measured MES using novel probe in the original circulation circuit model with artificial emboli. 2) We measured sonogram of carotid artery using novel probe attached to the cervix in healthy volunteers for 30 minutes, and then evaluated fixation ability and comfortability.

K. Hanzawa 1, A. Morishita 2, T. Nishimatsu 2
1 Niigata University Graduate School of Medicine and Dental Sciences,
2 Numata Neurosurgical and Cardiovascular Hospital – Numata, Japan

Objective: When we perform TEE in the patients with cerebral infarction, there are tandem lesions, such as both strand and aortic lesion. We attempted to clarify which findings relate HITS by TCD and determine the risk of embolic source.

Subjects and Methods: Subjected were 60 patients with symptomatic or asymptomatic cerebral infarction. All patients had performed TEE and detected HITS by TCD.

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