Application of transcranial Doppler sonography in children with acute neurologic events due to primary cerebral and West Nile vasculitis

Abstract

We describe the use of serial transcranial Doppler studies to evaluate neurovascular disease in three girls presenting with acute stroke due to primary cerebral vasculitis (n = 2) and West Nile vasculitis (n = 1). Correlation of abnormal findings on transcranial Doppler sonography was compared with those of MR angiography and conventional angiography in each child. All three girls had left middle cerebral artery infarcts on MR imaging, with an abnormal left middle cerebral artery detected by MR angiography, conventional angiography, and transcranial Doppler sonography in each child. In all three cases, findings of the transcranial Doppler sonography, MR imaging, and catheter angiography were concordant.

Fig 1.

Primary cerebral vasculitis in a 7-year-old girl. PSV indicates peak systolic velocity; MCA, middle cerebral artery; ICA, internal carotid artery, ACA, anterior cerebral artery. (A) Graph of transcranial Doppler sonography results plotted for 28 months show gradual improvement in all left-sided vessels. Note variation of individual measurements compared with trends over time. (B) Transcranial Doppler sonography spectrum shows elevated peak systolic velocities in the left MCA. (C) MR angiogram reveals decreased caliber of slightly irregular distal left ICA, A1 segment of the ACA, and M1 of the MCA (arrow). (D) Catheter angiogram obtained 2 days after initiation of therapy demonstrates slight narrowing and irregularity of the distal ICA (arrows). (E) Twenty-eight-month follow-up transcranial Doppler sonogram and (F) catheter angiogram show that the PSV and anatomical appearance of the vessels have returned to near normal.

Fig 2.

Primary cerebral vasculitis in a 12-year-old girl. Graph of transcranial Doppler sonography results plotted for 14 months demonstrates some improvement in the left internal carotid artery (ICA) and anterior cerebral artery (ACA) but persistent disease in the left middle cerebral artery (MCA).

Fig 3.

West Nile vasculitis in a 9-year-old girl. MCA indicates middle cerebral artery; ICA, internal carotid artery, ACA, anterior cerebral artery. (A) Graph of transcranial Doppler sonography results plotted for 8 months reveal persistence of elevated peak systolic velocity in the left MCA, ACA, and ICA. (B) MR angiogram reveals decreased caliber and irregularity of the left MCA with slight narrowing of the supraclinoid ICA and A1 segment of the ACA (arrows).