Replies to This Discussion

Permalink Reply by Timothy McKeever on March 3, 2010 at 9:08pm

Dr. Hyde,

We use a 2.5MHz probe as well. It is actually similar to a cardiac probe. I encountered a very difficult study today. The patient had coils implanted for a sub-arachnoid hemorrage. I could positively identify the peduncles and see the proximal PCA, and the P2 on one side. I was able to obtain proximal MCA bilaterally and a distal MCA on one side. The ACA was only barely visualized on one side. Samples were obtainable on both vertebrals and the proximal basilar from the suboccipital window. Opthalmic velocities were obtained as were the distal ICA's.

All of the velocity waveforms demonstrated a triphasic morphology even though they all indicated flow in the proper direction. The mean velocities were all very depressed.The patients blood pressure was 95/65 with a MAP of 65 and a heart rate of 111 wich peaked at 121 by the end of the examination. I am fairly new at transcranial examinations and I spent a great deal of time verifying the few observable landmarks I could see. While the study wasn't much of a confidence builder, it was interesting and the only one I have seen with that type of velocity profile. Was this due to intracranial swelling? I overheard two physicians discussing whether this patient would be a candidate for organ donation, so it sounded as if the prognosis is poor. What is your intuition about this case? Any feedback would be appreciated and of course, considered only as a learning type of discussion.

Permalink Reply by Thanh Tung Bui on May 11, 2010 at 8:41am

Hi ,
I would recommend everyone the reference book. Book of Dr. Alexandrov about stroke and transcranial Doppler. We can see all the normal range MFV (mean flow velocity) as well as PI (pulsatility index) and waveform recogition. Excellent book.

Timothy McKeever said:

Dr. Hyde,

We use a 2.5MHz probe as well. It is actually similar to a cardiac probe. I encountered a very difficult study today. The patient had coils implanted for a sub-arachnoid hemorrage. I could positively identify the peduncles and see the proximal PCA, and the P2 on one side. I was able to obtain proximal MCA bilaterally and a distal MCA on one side. The ACA was only barely visualized on one side. Samples were obtainable on both vertebrals and the proximal basilar from the suboccipital window. Opthalmic velocities were obtained as were the distal ICA's.

All of the velocity waveforms demonstrated a triphasic morphology even though they all indicated flow in the proper direction. The mean velocities were all very depressed.The patients blood pressure was 95/65 with a MAP of 65 and a heart rate of 111 wich peaked at 121 by the end of the examination. I am fairly new at transcranial examinations and I spent a great deal of time verifying the few observable landmarks I could see. While the study wasn't much of a confidence builder, it was interesting and the only one I have seen with that type of velocity profile. Was this due to intracranial swelling? I overheard two physicians discussing whether this patient would be a candidate for organ donation, so it sounded as if the prognosis is poor. What is your intuition about this case? Any feedback would be appreciated and of course, considered only as a learning type of discussion.

Permalink Reply by Syed Amir Gilani on July 31, 2011 at 5:21am

i am using 2mhz with mylab50,trying to get good images as i have started it this year

Permalink Reply by Syed Amir Gilani on September 17, 2011 at 2:56pm

Good--u r doing great job- I USE 2 MhZ --