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Transcranial Doppler ultrasound

Transcranial Doppler ultrasonography; TCD ultrasonography; TCD; Transcranial Doppler study

Transcranial doppler ultrasound (TCD) is a diagnostic test. It measures blood flow to and within the brain.

How the Test is Performed

TCD uses sound waves to create images of the blood flow inside the brain.

This is how the test is performed:

  • You will lie on your back on a padded table with your head and neck on a pillow. Your neck is stretched slightly. Or you may sit on a chair.
  • The technician applies a water-based gel on your temples and eyelids, under your jaw, and at the base of your neck. The gel helps the sound waves get into your tissues.
  • A wand, called a transducer, is moved over the area being tested. The wand sends out sound waves. The sound waves go through your body and bounce off the area being studied (in this case, your brain and blood vessels).
  • A computer looks at the pattern that the sound waves create when they bounce back. It creates a picture from the sound waves. The Doppler creates a "swishing" sound, which is the sound of your blood moving through the arteries and veins.
  • The test can take 30 minutes to 1 hour to complete.

How to Prepare for the Test

No special preparation is needed for this test. You do not need to change into a medical gown.

Remember to:

  • Remove contact lenses before the test if you wear them.
  • Keep your eyes closed when gel is applied to your eyelids so you don't get it in your eyes.

How the Test will Feel

The gel may feel cold on your skin. You may feel some pressure as the transducer is moved around your head and neck. The pressure should not cause any pain. You may also hear a "whooshing" sound. This is normal.

Why the Test is Performed

The test is done to detect conditions that affect blood flow to the brain:

  • Narrowing or blockage of the arteries in the brain
  • Stroke or transient ischemic attack (TIA or ministroke)
  • Bleeding in the space between the brain and the tissues that cover the brain (subarachnoid hemorrhage)
  • Ballooning of a blood vessel in the brain (cerebral aneurysm)
  • Change in pressure inside the skull (intracranial pressure)
  • Sickle cell anemia, to assess stroke risk

Normal Results

A normal report shows normal blood flow to the brain. There is no narrowing or blockage in the blood vessels leading to and within the brain.

What Abnormal Results Mean

An abnormal result means an artery may be narrowed or something is changing the blood flow in the arteries of the brain.

Risks

There are no risks with having this procedure.

References

Defresne A, Bonhomme V. Multimodal monitoring. In: Prabhakar H, ed. Essentials of Neuroanesthesia. Cambridge, MA: Elsevier Academic Press; 2017:chap 9.

Ellis JA, Yocum GT, Ornstein E, Joshi S. Cerebral and spinal cord blood flow. In: Cottrell JE, Patel P, eds. Cottrell and Patel's Neuroanesthesia. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 2.

Matta B, Czosnyka M. Transcranial doppler ultrasonography in anesthesia and neurosurgery. In: Cotrell JE, Patel P, eds. Cottrell and Patel's Neuroanesthesia. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 7.

Newell DW, Monteith SJ, Alexandrov AV. Diagnostic and therapeutic neurosonology. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 363.

Sharma D, Prabhakar H. Transcranial Doppler ultrasonography. In: Prabhakar H, ed. Neuromonitoring Techniques. Cambridge, MA: Elsevier Academic Press; 2018:chap 5.

Purkayastha S, Sorond F. Transcranial Doppler ultrasound: technique and application. Semin Neurol. 2012; 32(4):411-420. PMCID: 3902805 www.ncbi.nlm.nih.gov/pmc/articles/PMC3902805/.

Text only

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    Endarterectomy

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  • Cerebral aneurysm

    Cerebral aneurysm - illustration

    Weakness, numbness, or other loss of nerve function may indicate that an aneurysm may be causing pressure on adjacent brain tissue. Symptoms such as a severe headache, nausea, vomiting, vision changes or other neurological changes can indicate the aneurysm has ruptured and is bleeding into the brain. A ruptured intracranial aneurysm causes intracranial bleeding and is considered very dangerous.

    Cerebral aneurysm

    illustration

  • Transient Ischemic attack (TIA)

    Transient Ischemic attack (TIA) - illustration

    A transient ischemic attack (TIA) is caused by a temporary state of reduced blood flow in a portion of the brain. This is most frequently caused by tiny blood clots that temporarily occlude a portion of the brain. A primary blood supply to the brain is through two arteries in the neck (the carotid arteries) that branch off within the brain to multiple arteries that supply specific areas of the brain. During a TIA, the temporary disturbance of blood supply to an area of the brain results in a sudden, brief decrease in brain function.

    Transient Ischemic attack (TIA)

    illustration

  • Atherosclerosis of internal carotid artery

    Atherosclerosis of internal carotid artery - illustration

    The build-up of plaque in the internal carotid artery may lead to narrowing and irregularity of the artery's lumen, preventing proper blood flow to the brain. More commonly, as the narrowing worsens, pieces of plaque in the internal carotid artery can break free, travel to the brain and block blood vessels that supply blood to the brain. This leads to stroke, with possible paralysis or other deficits.

    Atherosclerosis of internal carotid artery

    illustration

    • Endarterectomy

      Endarterectomy - illustration

      Endarterectomy is a surgical procedure removing plaque material from the lining of an artery.

      Endarterectomy

      illustration

    • Cerebral aneurysm

      Cerebral aneurysm - illustration

      Weakness, numbness, or other loss of nerve function may indicate that an aneurysm may be causing pressure on adjacent brain tissue. Symptoms such as a severe headache, nausea, vomiting, vision changes or other neurological changes can indicate the aneurysm has ruptured and is bleeding into the brain. A ruptured intracranial aneurysm causes intracranial bleeding and is considered very dangerous.

      Cerebral aneurysm

      illustration

    • Transient Ischemic attack (TIA)

      Transient Ischemic attack (TIA) - illustration

      A transient ischemic attack (TIA) is caused by a temporary state of reduced blood flow in a portion of the brain. This is most frequently caused by tiny blood clots that temporarily occlude a portion of the brain. A primary blood supply to the brain is through two arteries in the neck (the carotid arteries) that branch off within the brain to multiple arteries that supply specific areas of the brain. During a TIA, the temporary disturbance of blood supply to an area of the brain results in a sudden, brief decrease in brain function.

      Transient Ischemic attack (TIA)

      illustration

    • Atherosclerosis of internal carotid artery

      Atherosclerosis of internal carotid artery - illustration

      The build-up of plaque in the internal carotid artery may lead to narrowing and irregularity of the artery's lumen, preventing proper blood flow to the brain. More commonly, as the narrowing worsens, pieces of plaque in the internal carotid artery can break free, travel to the brain and block blood vessels that supply blood to the brain. This leads to stroke, with possible paralysis or other deficits.

      Atherosclerosis of internal carotid artery

      illustration

    Tests for Transcranial Doppler ultrasound

     
     

    Review Date: 2/12/2019

    Reviewed By: Alireza Minagar, MD, MBA, Professor, Department of Neurology, LSU Health Sciences Center, Shreveport, LA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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