The most important is the qualitative analysis of the spectrograms with the definition of specific patterns of oscillating or reverberating flow, indicating the development of circulatory blood arrest. Quantitative parameters, including systolic velocity, the index of Gosling, volumetric flow rate are more unsteady than qualitative ones and in patients with BD depend generally on two factors – level of systolic blood pressure and intracranial pressure during the investigation [6], [14], [15] and [16]. Although there are some reports that showed that a decrease in the total volume of cerebral blood flow below 100 ml/min is in line with 100% mortality [17] and [18].

PFT�� nmr As it was shown in our study, the combination of intracranial and extracranial tests increased the sensitivity of the study up to 100%. The sensitivity Forskolin cost of isolated transcranial color duplex scanning was lower and depended on the time when the test was carried on in patients who had their clinical symptoms developed. The maximum sensitivity was 90% when the test was performed

in the early period and decreased to 80% when the investigation was done 6 h after the symptom manifestation. In addition, another factor which makes difficulty in interpretation of ultrasound data is previous extensive resection craniotomy in neurosurgical patients. In this case, the intracranial pressure is usually much lower. Here TCD is supposed to prolong the period when diagnosis of BD will be established. Although in any case, the typical ultrasound picture of circulatory blood arrest is developed with the lapse

of time [19]. Cerebral angiography remains a “gold standard” of diagnostics in angiology. It should be noted that in cases with craniotomy, even when cerebral angiography was performed, there is flow of contrast into the cranial cavity, which makes the interpretation of the clinical data difficult [20], [21], [22] and [23]. BD is a clinical diagnosis Selleck Decitabine and any confirmatory tests are auxiliary. The diagnosis of BD cannot be based only on confirmatory tests and neurologic criteria assessment is required. CDS of patients with BD reveals oscillating flow or systolic spikes in distal ICA, VA, intracranial vessels and spontaneous echo contrast in proximal ICA. In TCD, the most common finding is MCA with reverberating flow. There are some difficulties in detection of basilar system and it depends on the time of BD manifestation. The optimum combination is extracranial and intracranial scanning in the early stages of BD. “
“The internal jugular vein (IJV) forms as an extension of the sigmoid sinus and leaves the cranial cavity through the jugular foramen. Similar to the distal part of the internal carotid artery, the slight dilatation at the origin of the IJV, called the superior bulb, and the proximal part of the vessel cannot be insonated due to lack of access because of the mandible.