Local cerebral blood flow assessment using transcranial Doppler ultrasonography in a dog with brain infarction in the right middle cerebral artery territory.

A 12-year-old neutered male Chihuahua was diagnosed with acute brain infarction in the right middle cerebral artery (MCA) territory. Transcranial Doppler ultrasonography (TCD) was performed to assess the local cerebral blood flow at the time of diagnosis and after 4 and 31 hr. Initially, the right MCA retained blood flow but with a lower cerebral blood flow velocity (CBFV; 14.9 cm/sec) than the left MCA (27.9 cm/sec). The TCD vascular resistance variables were higher in the right than in the left MCA. An increase in the CBFV and a decrease in TCD vascular resistance variables were observed, consistent with improvements in neurological symptoms. TCD can be a non-invasive, and easy-to-use modality for bedside monitoring of cerebral edema and infarction.

Transcranial Doppler ultrasonography detects the elevation of cerebral blood flow during ictal-phase of pentetrazol-induced seizures in dogs.

OBJECTIVE: To investigate the association between changes in cerebral blood flow and electrographic epileptic seizure in dogs using transcranial Doppler ultrasonography (TCD). ANIMALS: 6 healthy Beagle dogs. PROCEDURES: Each dog was administered pentetrazol (1.5 mg/kg/min) or saline (0.9% NaCl) solution under general anesthesia with continuous infusion of propofol. Both pentetrazol and saline solution were administered to all 6 dogs, with at least 28 days interval between the experiments. Blood flow waveforms in the middle cerebral artery and the basilar artery were obtained using TCD at baseline, after pentetrazol administration, and after diazepam administration. TCD velocities, including peak systolic velocity, end-diastolic velocity, and mean velocity and resistance variables, were determined from the Doppler waveforms. RESULTS: During ictal-phase of pentetrazol-induced seizures, the TCD velocities significantly increased in the basilar and middle cerebral arteries while TCD vascular resistance variables did not change in either artery. The TCD velocities significantly decreased after diazepam administration. Systemic parameters, such as the heart rate, mean arterial pressure, systemic vascular resistance, cardiac index, end-tidal carbon dioxide, oxygen saturation, and body temperature, did not change significantly during seizures. CLINICAL RELEVANCE: This study showed that cerebral blood flow, as obtained from TCD velocities, increased by 130% during ictal-phase of pentetrazol-induced seizures in dogs. The elevated velocities returned to baseline after seizure suppression. Thus, TCD may be used to detect electrographic seizures during the treatment of status epilepticus in dogs, and further clinical studies clarifying the association between changes in cerebral blood flow and non-convulsive seizure cases are needed.

Transcranial Doppler Ultrasound Examination in Dogs with Suspected Intracranial Hypertension Caused by Neurologic Diseases.

BACKGROUND: Transcranial Doppler ultrasound examination (TCD) is a rapid, noninvasive technique used to evaluate cerebral blood flow and is useful for the detection of intracranial hypertension in humans. However, the clinical usefulness of TCD in diagnosing intracranial hypertension has not been demonstrated for intracranial diseases in dogs. OBJECTIVES: To determine the association between the TCD variables and intracranial hypertension in dogs with intracranial diseases. ANIMALS: Fifty client-owned dogs with neurologic signs. METHODS: Cross-sectional study. All dogs underwent TCD of the basilar artery under isoflurane anesthesia after magnetic resonance imaging (MRI). Dogs were classified into 3 groups based on MRI findings: no structural diseases (group I), structural disease without MRI evidence of intracranial hypertension (group II), and structural disease with MRI evidence of intracranial hypertension (group III). The TCD vascular resistance variables (resistive index [RI], pulsatility index [PI], and the ratio of systolic to diastolic mean velocity [Sm/Dm]) were measured. RESULTS: Fifteen, 22, and 13 dogs were classified into groups I, II, and III, respectively. Dogs in group III had significantly higher Sm/Dm (median, 1.78; range, 1.44-2.58) than those in group I (median, 1.63; range, 1.43-1.75) and group II (median, 1.62; range, 1.27-2.10). No significant differences in RI and PI were identified among groups. CONCLUSIONS AND CLINICAL IMPORTANCE: Our findings suggest that increased Sm/Dm is associated with MRI findings of suspected intracranial hypertension in dogs with intracranial diseases and that TCD could be a useful tool to help to diagnose intracranial hypertension.

Transcranial sonography: a technique for the study of the temporal lobes of the human and non-human primate brain.

We developed a modified transcranial sonography technique to study the morphology of the temporal lobe, a brain region involved in language, memory and social functions in humans that can be visualized in correspondence of the acoustic window of the temporal squama. Previous studies raise the possibility that a unique derived feature of Homo sapiens is a relatively larger temporal lobe compared to those of other hominins and apes. Such a brain reorganization might have contributed to the evolution of various "higher" cognitive functions of Homo sapiens, including language. Hence, the importance of further comparative analyses of the temporal region. With the technique that we developed we were able to study the meninges, the subarachnoidal space and the cortex of the human temporal lobe. The spatial resolution and the ability to visualize structures of 200-300 microm size led us to hypothesize that the linear structures parallel to the subarachnoidal space might be referred to the neuronal layers of the cortex. The low cost, simplicity and safety of the procedure suggest that this technique may have a significant potential in the comparative study of the primate temporal lobe. Furthermore, the procedure described here can also be used for the study of vascularization of the meninges, in order to better understand the evolutionary relationships between the neurocranial shape and the middle meningeal vessels in living and fossil human species.

Transcranial Doppler sonographic findings in granulomatous meningoencephalitis in small breed dogs.

Granulomatous meningoencephalitis (GME) is an acute, progressive, and often fatal inflammatory disease of the central nervous system, affecting mainly small and toy dog breeds. A definitive diagnosis of GME can only be achieved through histopathologic examination of samples collected after death. This retrospective study describes transcranial Doppler ultrasonography (TDS) findings in dogs with confirmed clinical histopathology of GME. Eleven dogs were selected for this study. Sonographic findings in B-mode demonstrated diffuse decreased brain parenchyma echogenicity in 9 dogs, ventriculomegaly in 8 dogs, brain atrophy in 4 dogs, and hyperechoic focal lesions in 6 dogs. Color Doppler imaging revealed more obvious vessels of the arterial circle in 10 dogs. Spectral Doppler examination was performed in 10 dogs to detect the 6 major cerebral arteries of interest. The examination showed normal and high resistive index (RI) values in the outlined arteries. The TDS findings were consistent with pathology found on postmortem examination.

RésuméConstatations échographiques Doppler transcrâniennes pour la méningoencéphalite granulomateuse chez les chiens de petite race. La méningoencéphalite granulomateuse (MEG) est une maladie inflammatoire aiguë, progressive et souvent mortelle du système nerveux central qui touche surtout les chiens de petite race. Un diagnostic définitif de MEG peut seulement être obtenu par un examen histopathologique des échantillons recueillis après la mort. Cette étude rétrospective décrit les constatations d'une échographie Doppler transcrânienne (EDT) chez les chiens avec une histopathologie clinique confirmée de MEG. Onze chiens ont été sélectionnés pour cette étude. Les constatations échographiques en mode-B ont démontré une échogénécité diffuse réduite du parenchyme du cerveau chez 9 chiens, une ventriculomégalie chez 8 chiens, une atrophie du cerveau chez 4 chiens et des lésions focales hyperéchogènes chez 6 chiens. Une imagerie Doppler en couleur a révélé des vaisseaux plus évidents du cercle artériel chez 10 chiens. L'examen spectral Doppler a été réalisé chez 10 chiens pour détecter les 6 artères cérébrales majeures d'intérêt. L'examen a montré des valeurs d'indice de résistivité (IR) normales et hautes dans les artères indiquées. Les constatations de l'EDT étaient conformes à celles de la pathologie trouvées à l'examen postmortem.(Traduit par Isabelle Vallières).

Imaging diagnosis-transcranial color-coded duplex sonography in a dog with hepatic encephalopathy.

We report the use of transcranial Doppler ultrasonography in a dog with hepatic encephalopathy secondary to a congenital portosystemic shunt. A severe increase in the pulsatility index was measured in the right middle cerebral artery, left middle cerebral artery, and basilar artery. These values returned to normal following medical stabilization of the patient and resolution of the neurologic signs. Transcranial Doppler ultrasonography appears to have value for monitoring the status of intracranial hypertension in patients with hepatic encephalopathy.

Assessing Circle of Willis blood circulation in dogs with transcranial color-coded duplex sonography.

Insonation of Circle of Willis by transcranial Doppler duplex color sonography is described in 30 healthy dogs with 15 weighing < 33 lb and 15 weighing >33 lb. Imaging was via a temporal window to explore the rostral, middle, and caudal cerebral arteries on both the left and right-hand sides; and through an suboccipital window to study the basilar artery. Normal mean values of the peak systolic velocity (PSV), end diastolic velocity, mean velocity, resistance index (RI), and pulsatility index (PI) were characterized and compared with those obtained in previous studies. There was significant differences in the PSV, RI, and PI in the rostral cerebral artery between dogs weighing < 33 vs. > 33 lb. Mean PSV was higher in weighing over 33 lb, whereas the mean resistive index and mean PI were lower in these dogs.

Quantitative evaluation of contrast enhanced transcranial Doppler signal using galactose based echo-contrast agent in dogs.

Transcranial Doppler ultrasonography (TCD) is hindered by insufficient ultrasound penetration through the temporal bone. The use of echo-contrast agents to enhance the Doppler signal is an important step toward the solution of this problem. The aim of the present study was to investigate the tolerability and diagnostic value of the intravenous echo-contrast agent, Levovist. Levovist was administered intravenously in 8 dogs with two doses (0.2 and 0.3 ml/kg) at different concentrations (300 and 400 mg/ml). In right middle cerebral artery (RMCA), the duration and degree of the signal enhancement were measured by TCD. All 32 administrations of Levovist produced an increase in TCD signal of the RMCA without complications. The first assessable pulse curve could be seen on the screen after 4 to 7 seconds after injection. There was no significant difference of latency period between different concentration and dosage. The signal amplitude was increased homogeneously by more than 30 dB when 0.3 ml/kg with 300 mg/ml concentration of Levovist and 0.2 and 0.3 ml/kg with 400 mg/ml concentration were administered. There was no significant difference in the duration of optimal contrasting between 0.3 ml/kg with 300 mg/ml concentration of Levovist and 0.2 and 0.3 ml/kg with 400 mg/ml concentration. The duration of the signal enhancement was 144 to 422 seconds, depending on the degree of concentration and dose of administration. Optimal TCD signal enhancement of RMCA was obtained using 0.3 ml/kg with 300 mg/ml concentration of Levovist in dogs, which is considered to provide quality visualization.

Identification of arachnoid cysts in the quadrigeminal cistern using ultrasonography.

The ultrasonographic findings in three small breed dogs with intracranial arachnoid cysts are described. Ultrasound images were obtained via the foramen magnum, temporal window and persistent bregmatic fontanelle (when possible). In transverse, dorsal and sagittal transcranial ultrasound images there was marked dilation of the lateral ventricles and a well-defined, oval to triangular-shaped anechoic area between the caudal aspect of the occipital lobes, dorsal to the midbrain, and rostral to the cerebellum. These findings were consistent with a diagnosis of concurrent hydrocephalus and an arachnoid cyst within the quadrigeminal cistern.

Evaluation of intracranial pressure by transcranial Doppler ultrasonography in dogs with intracranial hypertension.

Transcranial Doppler ultrasonography (TCD) has been used to confirm changes in cerebral hemodynamics. In this study, we investigated whether the parameters for the basilar artery measured by TCD were correlated with the intracranial and cerebral perfusion pressures in extreme intracranial hypertension. An intracranial hypertension model was produced in seven dogs by inflating a balloon inserted into the epidural space. The resistance index was compared with the corresponding intracranial pressure and cerebral perfusion pressure values during intracranial hypertension. A significant correlation was recognized between the resistance index and cerebral perfusion pressure. Therefore, measurement of the basilar artery by TCD in the dog with intracranial hypertension is useful in estimating the intracranial circulation in cases where the measurement of intracranial pressure is not available or not indicated.

The comparison between the cerebral blood flow directly measures and cerebral blood flow velocity in the middle and basilar cerebral arteries measured by transcranial Doppler ultrasonography.

Transcranial Doppler ultrasonography (TCD) may be useful for determining alterations in cerebral blood flow (CBF) during excessive hemodynamic changes by non-invasive measurement of the CBF velocity. The purpose of this study was to measure the correlation between CBF and the middle cerebral artery (MCA) and basilar artery (BA) flow velocities, as measured by TCD during excessive hemodynamic changes produced by hypertension and hypotension in adult dogs. The peak, diastolic, and mean flow velocities were measured by TCD. Arterial hypertension was induced by administration of dopamine at 5 and 15 microg/kg/min, and hypotension was induced by hemorrhage. During the hemodynamic changes, the BA velocity correlated more closely with the alteration in the CBF than the MCA velocity. In terms of percentages of the values during anesthesia, there was good correlation between CBF and the MCA and BA velocities. In conclusion, our findings indicate that MCA and BA velocity measurements, as a percentage of the values during anesthesia, both give an equally accurate indication of alterations in CBF during excessive hemodynamic changes.