Perspectives in Medicine (2012) 1, iiivii

Bartels E, Bartels S, Poppert H (Editors):

New Trends in Neurosonology and Cerebral Hemodynamics an Update.
Perspectives in Medicine (2012) 1, 112

journal homepage: www.elsevier.com/locate/permed

Contents
Prefaces
The European Society of Neurosonology and Cerebral Hemodynamics (ESNCH)
D. Russell, E.B. Ringelstein, K. Niederkorn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Foreword
L. Csiba . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Foreword
E. Bartels, S. Bartels, H. Poppert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

1 Advances in Neurosonology Brain Perfusion, Sonothrombolysis, Plaque Perfusion

Advances in neurosonology Brain perfusion, sonothrombolysis and CNS drug delivery
S. Meairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Sonothrombolysis: Current status
P.D. Schellinger, C.A. Molina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Sonothrombolysis for treatment of acute ischemic stroke: Current evidence and new developments
J. Eggers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Current trends in sonothrombolysis for acute ischemic stroke
A.V. Alexandrov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Safety evaluation of superheated peruorocarbon nanodroplets for novel phase change type neurological
therapeutic agents
J. Shimizu, R. Endoh, T. Fukuda, T. Inagaki, H. Hano, R. Asami, K.-i. Kawabata, M. Yokoyama,
H. Furuhata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Update on ultrasound brain perfusion imaging
G. Seidel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Brain tissue perfusion monitoring using Sonopod for transcranial color duplex sonography
T. Shiogai, M. Koyama, M. Yamamoto, K. Yoshikawa, T. Mizuno, M. Nakagawa . . . . . . . . . . . . . . . 34
Relationship between rell-kinetics of ultrasound perfusion imaging and vascular obstruction in acute
middle cerebral artery stroke
M. Bolognese, D. Artemis, A. Alonso, M.G. Hennerici, S. Meairs, R.R. Kern . . . . . . . . . . . . . . . . . 39
Imaging of plaque perfusion using contrast-enhanced ultrasound Clinical signicance
E. Vicenzini, M.F. Giannoni, G. Sirimarco, M.C. Ricciardi, M. Toscano, G.L. Lenzi, V. Di Piero . . . . 44
Plaque angiogenesis identication with Contrast Enhanced Carotid Ultrasonography: Statement of the
Consensus after the 16th ESNCH Meeting Munich, 20-23 May 2011
H. Poppert, E. Vicenzini, K. Stock, E. Bartels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

2 Novel Technologies
Mechanical recanalization in acute stroke treatment
P. Mordasini, G. Schroth, J. Gralla . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Functional guidance in intracranial tumor surgery
S.M. Krieg, F. Ringel, B. Meyer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Endovascular sono-lysis using EKOS system in acute stroke patients with a main cerebral artery occlusion
A pilot study
M. Kuliha, M. Roubec, T. Fadrn, D. Sank, R. Herzig, T. Jonszta, D. Czerny , J. Krajca, V. Prochzka,
D. Skoloudk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

http://dx.doi.org/10.1016/S2211-968X(12)00138-6
iv Contents

Act on Stroke Optimization of clinical processes and workow for stroke diagnosis and treatment
B.M. Hofmann, U. Zikeli, E.B. Ringelstein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Telestroke How does that work?
S. Boy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Ultrasound fusion imaging
J. Stoll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Threedimensional imaging of carotid arteries: Advantages and pitfalls of ultrasound investigations
E. Vicenzini, S. Pro, G. Sirimarco, P. Pulitano, O. Mecarelli, G.L. Lenzi, V. Di Piero . . . . . . . . . . . 82
Four-dimensional ultrasound imaging in neuro-ophthalmology
E. Titianova, S. Cherninkova, S. Karakaneva, B. Stamenov . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Clinical application of laser Doppler owmetry in neurology
Z. Stoyneva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

3 Stroke Prevention, Diagnostics and Therapy

The role of extracranial ultrasound in the prevention of stroke based on the new guidelines
B. Lrnt, L. Csiba . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Optimized prevention of stroke: What is the role of ultrasound?
D. Sander . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Measuring the degree of internal carotid artery stenosis
G.-M. von Reutern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Early ultrasound imaging of carotid arteries in the acute ischemic cerebrovascular patients
M.F. Giannoni, E. Vicenzini, E. Sbarigia, V. Di Piero, G.L. Lenzi, F. Speziale . . . . . . . . . . . . . . . . 108
How to treat an asymptomatic carotid stenosis? The view of the neurologist
D. Sander, M. Valet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Medical management of asymptomatic carotid stenosis
M. Jauss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
When to perform transcranial Doppler to predict cerebral hyperperfusion after carotid endarterectomy?
C.W. Pennekamp, S.C. Tromp, R.G. Ackerstaff, M.L. Bots, R.V. Immink, W. Spiering, J.-P.P. de Vries,
J. Kappelle, F.L. Moll, W.F. Buhre, G.J. de Borst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Predictors of carotid artery in-stent restenosis
K. Wasser, S. Grschel, J. Wohlfahrt, K. Grschel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Post-carotid stent ultrasound provides critical data to avoid rare but serious complications
J.J. Volpi, Z. Garami, R. Kabir, O. Diaz-Daza, R. Klucznik. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

4 Atherosclerotic Plaque, Intima-Media Thickness

How local hemodynamics at the carotid bifurcation inuence the development of carotid plaques
D. Liepsch, A. Balasso, H. Berger, H.-H. Eckstein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
In vivo wall shear stress patterns in carotid bifurcations assessed by 4D MRI
A. Harloff, M. Markl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Carotid intima-media thickness (cIMT) and plaque from risk assessment and clinical use to genetic
discoveries
S. Bartels, A.R. Franco, T. Rundek . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Arterial wall dynamics
G. Baltgaile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Morphological, hemodynamic and stiffness changes in arteries of young smokers
B. Lrnt, C. Straesser, R.K. Kovcs, L. Olh, L. Kardos, L. Csiba . . . . . . . . . . . . . . . . . . . . . . . . 152
Breath holding index and arterial stiffness in evaluation of stroke risk in diabetic patients
I. Zavoreo, V. Bas ic Kes, L. Coric , V. Demarin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Intima-media thickness of the carotid artery in OSAS patients
S. Andonova, D. Petkova, Y. Bocheva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
The association of carotid intima-media thickness (cIMT) and stroke: A cross sectional study
S. Harris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Carotid atherosclerosis: Socio-demographic issues, the hidden dimensions
F. Abd-Allah, N. Abo-Krysha, E. Baligh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Comparative in vivo and in vitro postmortem ultrasound assessment of intima-media thickness with
additional histological analysis in human carotid arteries
S. Farkas, S. Molnr, K. Nagy, T. Hortobgyi, L. Csiba . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
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5 Cerebral Hemodynamics in Ischemic Stroke

Hemodynamic causes of deterioration in acute ischemic stroke
G. Tsivgoulis, N. Apostolidou, S. Giannopoulos, V.K. Sharma . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Transcranial Doppler in acute stroke management A real-time bed-side guide to reperfusion and
collateral ow
C. Levi, H. Zareie, M. Parsons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Cerebral autoregulation in acute ischemic stroke
M. Reinhard, S. Rutsch, A. Hetzel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
Vertebral artery hypoplasia and the posterior circulation stroke
A.S. Szrazov, E. Bartels, P. Turc ni . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Volume ow rate
D. Ratanakorn, J. Keandaoungchan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Intra- and extracranial stenoses in TIA Findings from the Aarhus TIA-study: A prospective population-
based study
P. von Weitzel-Mudersbach, S.P. Johnsen, G. Andersen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Symptomatic intracranial stenosis: A university hospital-based ultrasound study
F. Viaro, F.M. Farina, A. Onofri, G. Meneghetti, C. Baracchini . . . . . . . . . . . . . . . . . . . . . . . . . 211

6 Detection of Microembolic Signals, Right-to-Left Shunt (Patent Foramen Ovale)

The contribution of microembolic signals (MES) detection in cardioembolic stroke
M.A. Ritter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Exploration of a zero-tolerance regime on cerebral embolism in symptomatic carotid artery disease
R.W.M. Keunen, A. van Sonderen, M. Hunfeld, M. Remmers, D.L. Tavy, S.F.T.M. de Bruijn,
A. Mosch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Late septic encephalopathy and septic shock are not associated with ongoing cerebral embolism
M. Hunfeld, M. Remmers, R. Hoogenboezem, M. Frank, M. van der Mee, H.S.M. Hazra, S.C. Tromp,
E.H. Boezeman, D.L. Tavy, R.W. Keunen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
Patent foramen ovale
S. Horner, K. Niederkorn, F. Fazekas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
Microbubble signal properties from PFO tests using transcranial Doppler ultrasound
C. Banahan, R. Patel, V. Jeyagopal, A. Mistri, J.P. Hague, D.H. Evans, E.M.L. Chung . . . . . . . . . . 232
Italian patent foramen ovale survey (I.P.O.S.): Early results
L. Caputi, G. Butera, E. Parati, G. Sangiorgi, E. Onorato, G.P. Anzola, M. Chessa, M. Carminati, G.P. Ussia,
I. Spadoni, G. Santoro, on behalf of IPOS investigators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
An increased frequency of right-to-left shunt in patients with chronic hyperventilation syndrome
J. Staszewski, K. Tomczykiewicz, B. Brodacki, R.A. Piusin ska-Macoch, A. Ste pien , Z. Podgajny,
P. Smuzynski, M. Zarebinski . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241

7 Non Atherosclerotic Stroke Etiology

Diagnosis of non-atherosclerotic carotid disease
A. Lovrencic-Huzjan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
Ultrasound in spontaneous cervical artery dissection
R. Dittrich, M.A. Ritter, E.B. Ringelstein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
Diagnosis and management of Takayasu arteritis
N. Venketasubramanian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Moyamoya like arteriopathy: Neurosonological suspicion and prognosis in adult asymptomatic patients
G. Malferrari, M. Zedde, G. De Berti, M. Maggi, N. Marcello . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Posttraumatic vasospasm and intracranial hypertension after wartime traumatic brain injury
R.A. Armonda, T.A. Tigno, S.M. Hochheimer, F.L. Stephens, R.S. Bell, A.H. Vo, M.A. Severson,
S.A. Marshall, S.M. Oppenheimer, R. Ecker, A. Razumovsky . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Role of TCD in sickle cell disease: A review
V.F. Ztola . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Transcranial Doppler sonography in children with sickle cell disease and silent ischemic lesions
F.M. Farina, P. Rampazzo, L. Sainati, R. Manara, A. Onofri, R. Colombatti, C. Baracchini,
G. Meneghetti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Intellectual impairment and TCD evaluation in children with sickle cell disease and silent stroke
A. Onofri, M. Montanaro, P. Rampazzo, R. Colombatti, F.M. Farina, R. Manara, L. Sainati, M. Ermani,
C. Baracchini, G. Meneghetti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
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8 Cerebral Autoregulation and Functional Testing

Cerebral blood ow velocity in sleep
J. Klingelhfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Asymmetry of cerebral autoregulation does not correspond to asymmetry of cerebrovascular pressure
reactivity
B. Schmidt , M. Czosnyka, J. Klingelhfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Adaptation of cerebral pressure-velocity hemodynamic changes of neurovascular coupling to orthostatic
challenge
P. Castro, R. Santos, J. Freitas, B. Rosengarten , R. Panerai, E. Azevedo . . . . . . . . . . . . . . . . . . 290
Are impaired endothelial function in the posterior cerebral circulation and intact endothelial function in
the anterior cerebral and systemic circulation associated with migraine: A post hoc study
D. Perko, J. Pretnar-Oblak, B. Zvan, M. Zaletel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Effect of helium on cerebral blood ow: A n = 1 trial in a healthy young person
S.M. Zinkstok, D. Bertens, J.R. de Kruijk, S.C. Tromp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
Cerebral blood ow in the chronic heart failure patients
T. Lepic, G. Loncar, B. Bozic, D. Veljancic, B. Labovic, Z. Krsmanovic, M. Lepic, R. Raicevic . . . . . 304
Withdraw of statin improves cerebrovascular reserve in radiation vasculopathy
J.J. Volpi, R. Kabir, Z. Garami, P. New . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
Informativity of pulsatility index and cerebral autoregulation in hydrocephalus
V. Semenyutin, V. Aliev, V. Bersnev, A. Patzak, L. Rozhchenko, A. Kozlov, S. Ramazanov . . . . . . . 311
The long-term effects of hypobaric and hyperbaric conditions on brain hemodynamic: A transcranial
Doppler ultrasonography of blood ow velocity of middle cerebral and basilar arteries in pilots and divers
S.-M. Fereshtehnejad, M. Mehrpour, S.M.H. Mahmoodi, P. Bassir, B. Dormanesh, M.R. Motamed . . . 316
Oscillating transcranial Doppler patterns of brain death associated with therapeutic maneuvers
P. Cardona, H. Quesada, L. Cano, J. Campelacreu, A. Escrig , P. Mora, F. Rubio . . . . . . . . . . . . . 321

9 Transcranial Duplex Ultrasonography

Transcranial color-coded duplex ultrasonography in routine cerebrovascular diagnostics
E. Bartels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Evaluation of very early recanalization after tPA administration monitoring by transcranial color-coded
sonography
H. Mitsumura, M. Yogo, R. Sengoku, H. Furuhata, S. Mochio . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Transcranial sonography of the cerebral parenchyma: Update on clinically relevant applications
U. Walter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
Intra- and post-operative monitoring of deep brain implants using transcranial ultrasound
U. Walter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344
Transcranial ultrasound in adults and children with movement disorders
J. Liman, M. Bhr, P. Kermer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Possibilities of transcranial color-coded sonography in pathology of deep brain veins in children
M. Abramova, I. Stepanova, S. Shayunova . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Transcranial sonography in psychiatric diseases
M.D. Mijajlovic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
The role of color duplex sonography in the brain death diagnostics
I.D. Stulin, D.S. Solonskiy, M.V. Sinkin, R.S. Musin, A.O. Mnushkin, A.V. Kascheev, L.A. Savin,
M.A. Bolotnov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 362

10 Cerebral and Cervical Venous Ultrasonography

Ultrasound examination techniques of extra- and intracranial veins
E. Stolz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366
Fact or ction: Chronic cerebro-spinal insufciency
C. Baracchini, P. Gallo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Chronic cerebrospinal venous insufciency in patients with multiple sclerosis: A case-control study from Iran
M. Mehrpour, N. Najimi, S.-M. Fereshtehnejad, F.N. Safa, S. Mirzaeizadeh, M.R. Motamed, M. Nabavi,
M.A. Sahraeian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
Ultrasound ndings of the optic nerve and its arterial venous system in multiple sclerosis patients with
and without optic neuritis vs. healthy controls
N. Carraro, G. Servillo, V.M. Sarra, A. Bignamini, G. Pizzolato, M. Zorzon . . . . . . . . . . . . . . . . . 381
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Virtual Navigator study: Subset of preliminary data about cerebral venous circulation
M. Zedde, G. Malferrari, G. De Berti, M. Maggi, L. Lodigiani . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Ipsilateral evaluation of the transverse sinus: Transcranial color-coded sonography approach in comparison
with magnetic resonance venography
M. Zedde, G. Malferrari, G. De Berti, M. Maggi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390
Intraoperative color-coded duplex sonography of the superior sagittal sinus in parasagittal meningiomas
V.B. Semenyutin, D.A. Pechiborsch, V.E. Olyushin, V.A. Aliev, V.Y. Chirkin, A.V. Kozlov,
G.K. Panuntsev . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
Italian multicenter study on venous hemodynamics in multiple sclerosis: Advanced Sonological Protocol
G. Malferrari, M. Del Sette, M. Zedde, S. Sanguigni, N. Carraro, C. Baracchini, M. Mancini,
E. Stolz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399

11 Nonvascular Neurosonography Muscle, Nerve and Eye

B-mode sonography of the optic nerve in neurological disorders with altered intracranial pressure
J. Buerle, M. Nedelmann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404
The retrobulbar spot sign in sudden blindness Sufcient to rule out vasculitis?
M. Ertl, M. Altmann, E. Torka, H. Helbig, U. Bogdahn, A. Gamulescu, F. Schlachetzki . . . . . . . . . . 408
Ultrasonography of the optic nerve sheath in brain death
A. Lovrencic-Huzjan, D.S. Simicevic, I.M. Popovic, M.B. Puretic, V.V. Cvetkovic, A. Gopcevic, M. Vucic,
B. Rode, V. Demarin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
Ultrasonography of the peripheral nervous system
H. Kele . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
Ultrasonography of peripheral nerves Clinical signicance
U. Schminke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422
An overview of musculoskeletal ultrasound A thirteen years experience in Pakistan
S.A. Gilani . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427
Four-dimensional ultrasound calf muscle imaging in patients with genetic types of distal myopathy
E. Titianova, T. Chamova, V. Guergueltcheva, I. Tournev . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431

12 Case Reports
A horse, a horse, my kingdom for a horse Saddle thrombosis of carotid bifurcation in acute stroke
E.B. Vicenzini, M.F. Giannoni, M.C. Ricciardi, G. Sirimarco, M. Toscano, G.L. Lenzi, V. Di Piero . . . 435
Intravascular papillary endothelial hyperplasia at the origin of internal carotid artery: A rare cause of
stroke
N. Carraro, V.M. Sarra, A. Gorian, F. Pancrazio, S. Bucconi, P. Martingano, G. Pizzolato, F.C. Grandi . . . 440
Reversible cerebral vasoconstriction syndrome after preeclampsia
R. Mller, O. Meier, R.L. Haberl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443
Transcranial and cervical duplex: A feasible approach to the diagnosis of pulsatile tinnitus
P. Cardona, H. Quesada, L. Cano, J. Campdelacreu, A. Escrig, P. Mora, F. Rubio . . . . . . . . . . . . . 446
Pitfall of vertebral artery insonation: Bidirectional ow without subclavian artery pathology
S. Johnsen, S.J. Schreiber, F. Connolly, K. Schepelmann, J.M. Valdueza . . . . . . . . . . . . . . . . . . . 449
Migraine-like presentation of vertebral artery dissection after cervical manipulative therapy
D. Jatuzis, J. Valaikiene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452
The impact of recanalization on ischemic stroke outcome: A clinical case presentation
S. Andonova, F. Kirov, C. Bachvarov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455
Semantic aphasia in a sonothrombolysed patient. A treatment without use of rt-PA
M. Klissurski, E. Vavrek, N. Nicheva-Vavrek . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459
My worst case with sonothrombolysis
E.V. Vavrek . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462
Transient brainstem ischemia and dural arteriovenous malformation
J. Valaikiene, J. Dementaviciene, D. Jatuzis, L. Cimbalistiene . . . . . . . . . . . . . . . . . . . . . . . . . 465
List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . III
Subject index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IX
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XVIII