2001 年 14 巻 3-4 号 p. 87-94
When undertaking diagnostic and treatment procedures for stroke patients, it is essential to evaluate vascular lesions at the extracranial and intracranial cerebral arteries and aortic arch and to look for underlying heart diseases. Ultrasonographic examination is particularly important in elderly or major stroke patients, because it is non-invasive and can be performed repeatedly at the bedside.
Transesophageal echocardiography has been widely used for exploring embolic sources in the heart and aortic arch in young and cryptic stroke patients. It frequently demonstrates complicated atherosclerotic lesions in the aortic arch and right-to-left shunts in the heart or lung, such as patent foramen ovale, pulmonary arteriovenous fistula with concomitant pulmonary embolism and deep vein thrombosis shown by venous ultrasonography. Transoral carotid ultrasonography gives us additional information to conventional carotid ultrasonography about the vascular pathology of the distal portion of the extracranial internal carotid artery and a transpulmonary contrast medium, which has made it easy to assess intracranial vascular structures, is now available. Contrast harmonic imaging is a novel technique for observing the state of brain perfusion, but it needs further study.
In conclusion, we recommend all stroke neurologists (strokologists) to become familiar with neurosonology for exploring the heart, aortic arch, extracranial and intracranial arteries and peripheral leg veins.