Avaliação Ultrassonográfica das Artérias Intracranianas

Valores de referência e desempenho diagnóstico pertencem às séries originais do livro, não são limiares universais. A linguagem terapêutica da Tabela 10.7 é histórica e não deve ser usada como protocolo de 2026. Perfusão ultrassonográfica e sonotrombólise aparecem como investigacionais na Tabela 10.9. Diretriz AHA/ASA 2023 aparece separada do texto de 2019. Os quadros de analogia são autorais, não falas atribuídas a Feynman.

1. Detection of intracranial stenoses and occlusions in
2. Evaluation of intracranial hemodynamic effects and occlusions, subclavian steal).
3. Monitoring of intracranial vessel recanalization in a
4. Monitoring of intracranial cerebral hemodynamics: a. After subarachnoid hemorrhage (e.g., presence a b. In patients with increased intracranial pressure ( c. During and after extracranial revascularization p carotid stent placement) d. Before and during neuroradiologic interventions pathways e. During open heart surgery f. In the evaluation of brain death
5. Detection and quantification of cerebral circulating
6. Detection and quantification of right-to-left shunts
7. Functional tests: a. Stimulation of intracranial arterioles with carbon vasomotor reserve capacity) b. Language lateralization (e.g., before neurosurge c. External stimulation of visual cortex
8. Still under investigation: a. Brain perfusion imaging b. Ultrasound-assisted thrombolysis
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13. Spencer MP, Whisler D. Transorbital Doppler diagnosis of intracranial arterial stenosis. Stroke; a Journal of Cerebral Circulation. 1986;17:916. tomographic images. Since then, a considerable number of papers described changes of B-mode ultrasound in varying types of movement disorders.21 Meanwhile, the technique has gained acceptance and can be used to identify patients at risk of Parkinson syndromes, to establish the risk for symptomatic disease, and to differentiate idiopathic PD from other Parkinson syndromes.21 In addition to the echogenic appearance of the substantia nigra of the brainstem, other areas of the brain can be used to establish a differential diagnosis. These include structures easily visualized through the transtemporal window: the width of the third ventricle, the echogenicity of the lenticular nucleus, the echogenicity of the Raphe, and the width of the cella media. The major limitation of the investigation is in fact the quality of the bone window, such that in patients with good insonation conditions, the reliability and the accuracy of the method is quite high. PRACTICAL TIPS • Direct imaging of the brain parenchyma can: • Help identify the landmarks where the major intracranial arteries lie TABLE 10.9 Main Indications for Vascular Coded Duplex Sonography in Clinical and Ex
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A diretriz AHA/ASA 2023 de hemorragia subaracnóidea aneurismática considera razoável monitorar por DTC para detectar vasoespasmo e prever isquemia cerebral tardia (classe 2a, nível B-NR); angio-TC e TC de perfusão podem ajudar quando há suspeita de vasoespasmo ou exame neurológico limitado. Para atualização clínica completa, consulte o tópico institucional do UpToDate: tratamento e prognóstico da HSA aneurismática, cuja revisão estava atualizada até setembro de 2026 na consulta de outubro de 2026. O conteúdo proprietário não foi reproduzido.

1. Indicação e método: DTC ou DTCC.
2. Janelas disponíveis e limitações ósseas.
3. Vasos e segmentos identificados, lado e profundidade.
4. Direção, velocidades, forma da onda e comparação entre lados.
5. Jato focal, colaterais, sinais transitórios e evolução seriada, se houver.
6. Conclusão proporcional ao achado e necessidade de correlação clínica ou imagem anatômica.