| Cerebral infarction is also called cerebral ischemic stroke, it is because the brain blood supply obstacle, ischemia, anoxia to cause of localized brain tissue ischemic necrosis or cerebromalacia, its most familiar cause is the lumen stenosis because of atheroscleorsis plaques and thrombosis. It is a kind of familiar disease, high outbreak that endanger people's health seriously, with the result that the disablement rate and fatality rate are all very high .Therefore for that disease, discovery early, examination early,and reasonable treatment in time seem to be more important .The final diagnosis of Cerebral infarction mainly depends on CT,MRI etc. Transcranial Doppler ultrasound (TCD) check is a diagnostic technique to utilize Doppler effect of ultrasonic to study the basicranial great vessels and the hemodynamics of its branch .We apply transcranial Doppler ultrasound (TCD) to examine the patients who were acute cerebral infarction totaling 80 cases ,and make contrasting and analyze with CT etc. to learn its diagnostic value,and approach its confidence, the advantage and localization in the clinical application to examine acute cerebral infarction.This study selected the inpatients, policlinic patients and health examiner who all come from the department of neurology in China-Japan Union Hospital of Jilin University from January,2005 to December,2006.They are divided into the cerebral infarction group totaling 80 and the control group totaling 50 to make contrasting and analyze by nervous system check-up and the skull CT or MRI check, and also divided into sub-group to make contrast and analyze by the infarction area size(big area, small area, lacunar infarction)and the distinct blood-supply area of intracranial arteries (front circulating, empress circulating, the watershed area).Examination used the French GK company EXPLORER model TCD examination instrument to detect basicranial vascular blood flow parameter of all who were selected, through comparing the abnormality genesis rate of Cerebral vessels to each group and each sub-group ,and comparing relationship to TCD shows diseased region and image check location (the data processing adoption X 2 examination and statistical package SPSS11.5),we want to approach the value and clinical meaning that TCD is used to diagnose acute cerebral infarction.The result of this study,19 cases of the big area Cerebral infarction group, the blood flow rate speed up 5 cases, the blood flow rate step down 11 cases, the signal disappear 2 cases, 1 the blood flow rate is normal;34 cases of the small area Cerebral infarction, the blood flow rate speed up 4 cases, the blood flow rate step down 16 cases,14 is normal;27cases of the lacunar infarction, the blood flow rate speed up 2 cases, the blood flow rate step down 12 cases,13 bloods are normal, three groups of abnormality of blood vessel rates distinguish to 94.7%,58.8%,51.9%, through statistics the analysis comparison, the abnormality of blood vessel rate of big area Cerebral infarction group shows more obviously higher than the small area Cerebral infarction group and the lacunar infarction group, explaining the brain artery pathological changes severity in the big area Cerebral infarction, condition is usually seriously and prognosis is not good. TCD has no statistics meaning towards examining the abnormality of blood vessel rate, between the small area Cerebral infarction and the lacunar infarction.80 cases of Cerebral infarction group, 11 cases appear blood flow rate speed up in different degree, thesegmental systolic phase, diastolic phase and average blood flow rate are all speed up, at the sametime also the turbulent flow, vortex flow and audiofrequency abnormality, can hear lofty tone musicogenic murmurs or rough murmurs, the reflection has already corresponded blood vessel stegnosis and spasm, the blood flow rate step down 39 cases, the frequency spectrum characteristics: Audiofrequency is rough, frequency spectrum is low and blunt, the signal is weaker, peak time moves behind, the contraction peak, end-diastolic phase and average blood flow rate is low in normal range low limit, the reflection corresponds blood vessel to blood-supply shortage, the signal disappear 2 cases, 28 cases is normal;50 health check-ups of the control group, the blood flow rate speed up 2 cases, the blood flow rate step down 6 cases, none of the blood signal disappear,42 is normal. Two groups of abnormality of blood vessel rates distinguish to 65.0% and 16.0%, through statistics the analysis comparison, the abnormality of blood vessel rate of Cerebral infarction group shows more obviously higher than the control group, the morbility of Cerebral infarction contains obvious pathologic foundation, before the infarction take place , brain artery of pathology changes already very widespread and severely, TCD check can discover its blood dynamics changes earlier, putting forward the outbreak risk of stroke in time, guiding a clinic prevention and curing, having important meanings. TCD can't explore blood flow parameter of leptos branches, in the Cerebral infarction group,28 cases are normal blood through TCD examination, having 35.0%, in the control group,8 cases are blood vessel abnormality, having 16.0%, it is clear that the specificity of TCD to examine acute Cerebral infarction is inferior to the imageology method ,such as CT and MRI etc., another its result ofexamination accuracy in the certain degree, depends on examiner,s knowledge, technique, experience and the influence of cranial bone voice window etc. factors easily, it exists certainly limitations.The infarction because of the great vasculopathy means Cerebral infarction due to intracranial or extracranial great vascellum stenosis or obliteration , if TCD can detect incarcerated or obliterative acutely blood-supply arteries which correspond Cerebral infarction of Clinical and the cranalis imageology ,that will provide diacritic evidences for the great arteries atherosclerotic stricture stroke. TCD which shows pathological changes part matches the rate of image checks location is 81.36% in this case, both didn't show the obvious difference, expressing that TCD can judge accurately pathological vassular part of Cerebral infarction through detecting the cerebullar hemodynamic changes in the Cerebral infarction area , so it can make a niveau diagnosis which combined clinic.In summery, through contrasting and analyze on the value of TCD to examine a patient with acute Cerebral infarction, we can draw conclusion as follow: the abnormality rate of blood vessel by transcranial Doppler ultrasound examining is related to infarction area, the wider of the infarction area,the higher of abnormality rate. The specificity of TCD to examine acute Cerebral infarction is inferior to the imageology method, such as CT and MRI etc.,can't be a authentic index for examining acute Cerebral infarction, be more suitable for the pathogenic risk forecast of disease and auxiliary diagnosis. CT and MRI can show the location and size accurately of focus of infarct, , but can't reflect the changes of brain hemodynamics and collateral circulation compensation circumstance, so they can't replace TCD check. The obviouslyconstrictive characteristic of Cerebral vessels through TCD, especially the evaluation of collateral circulation circumstance,have the important instruction worth and clinical meaning to the early diagnosis, condition valuation, treatment and prognosis of Cerebral infarction. TCD have the advantages of non-invasive, convenient operation , good repeatability, and obtain directly the hemodynamic parameter of cerebral arteries ,opposite cheap cost etc. TCD is a kind of important auxiliary examination to the acute Cerebral infarction. |
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