Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
The contribution of pulsating duplex Doppler ultrasonography to the diagnosis of middle (MCA) and anterior (ACA) cerebral artery obstruction in one patient is reported. A 10year-old boy was admitted to the hospital for pulsating headaches (especially pronounced on physical training). He had no neurologic disabilities. His EEG and brain CT scan were normal, and so were his funduscopic examination, lumbar puncture, and laboratory tests. Transcranial color duplex Doppler ultrasonography showed very high velocities in both ACA and right MCA as a sign of suspected stenosis or spasm. Bilateral subtraction cerebral angiography performed after several months of recurrent headaches and unchanged Doppler ultrasonography findings produced an image of high degree stenosis of A1 segment of both ACA and right MCA, with signs of ‘steal syndrome’ through the posterior cerebral circulation. MRI performed one year later, after episodes of transient ischemic attacks, showed ischemic infarction in the right temporo-occipital region. The etiology of stenosis was supposed to include vasculopathy, i.e. early stage of moyamoya syndrome. Other vasculopathies were excluded by laboratory tests and clinical elaboration. It is concluded that transcranial Doppler ultrasonography is a very helpful method for detection and follow-up of the degree of stenosis of great cerebral arteries in children, and that it correlates well with cerebral angiography, yet it is not useful in diagnosing the etiology of stenosis.Prikazan je slučaj 10-godišnjeg dječaka koji je primljen na Kliniku zbog pulsirajućih glavobolja koje su se najčešće javljale za vrijeme tjelesnog napora. Dječak je bio urednog somatskog i neurološkog statusa. Njegov EEG i CT mozga bili su uredni, kao i pregled očnog dna, likvora i laboratorijske pretrage. Transkranijski obojeni dupleks Doppler pokazao je izrazito velike brzine u objema prednjim moždanim arterijama (ACA) i u desnoj srednjoj moždanoj arteriji (MCA), što je moglo odgovarati stenozi krvnih aila. Subtrakcijska cerebralna angiografija učinjena je nakon nekoliko mjeseci opetovanih glavobolja i nepromijenjenog Doplerskog nalaza. Pokazala je veći stupanj stenoze prednjeg segmenta obiju ACA i početnog dijela desne MCA, sa znacima ‘sindroma krađe’ kroz stražnju moždanu cirkulaciju. MRI (učinjena godinu dana kasnije, nakon ponavljanih epizoda prolaznih ishemijskih napadaja) pokazala je ishemijski infarkt temporookcipitalno desno. Etiologija bolesti ostala je otvorenom. Pretpostavljeno je da se radi o vaskulopatiji, tj. ranom stadiju bolesti moyamoya. Ostale vaskulopatije isključene su laboratorijskim i kliničkim ispitivanjem. Zaključuje se kako je transkranijski obojeni dupleks Doppler vrlo dobra metoda za otkrivanje i praćenje stupnja stenoze moždanih arterija u djece i dobro korelira s cerebralnom angiografijom, ali još ne pomaže u otkrivanju etiologije stenoze
