Author/Editor		Pretnar-Oblak, Janja; Zaletel, Marjan
Title		Pomen transkranialne doplerske sonografije pri kriptogeni možganski kapi
Translated title		The significance of transcranial Doppler sonography in cryptogenic ischemic cerebrovascular infarction
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 46, št. 3
Publication year		2007
Volume		str. 213-20
Language		slo
Abstract		In about 40% of young adult patients with ischemic stroke, no cause can be detected. Such ischemic strokes are called cryptogenic. Studies have shown a higher frequency of open oval window (foramen) in young patients with ischemic stroke than in healthy subjects. In spite of a statistically clear association, however, the pathophysiological mechanism for the development of cryptogenic ischemic stroke in the case of open oval window is not yet known. Transesophageal echocardiography is considered the standard method for establishing patency of the oval window, but due to the invasiveness and long duration of this procedure, its accessibility is relatively low. Right-to-left shunt can also be proved with transcranial Doppler sonography, which along with the use of a contrast agent and the Valsalva maneuver is a sensitive screening method for patients with open oval window. The sensitivity of this method is between 91 and 100%, while its specificity is 94%. In patients with cryptogenic ischemic stroke and positive results of transcranial Doppler sonography, antiaggregation prophylaxis is indicated, along with further diagnostic management, including transesophageal echocardiography. If the results are negative, the right-to-left shunt and therefore also open oval window can be excluded with a high probability. Due to its high specificity and sensitivity, this method can serve as a good screening test for detecting right-to-left cardiac shunts.
Summary		Pri približno 40% mladih odraslih bolnikov z ishemično možgansko kapjo vzroka zanjo ne odkrijemo in govorimo o kriptogeni ishemični možganski kapi. Raziskave so pokazale večjo pogostnost odprtega ovalnega okna pri mlajših bolnikih z ishemično možgansko kapjo kot pri zdravih preiskovancih. Kljub statistično jasni povezavi pa patofiziološki mehanizem kriptogene ishemične možganske kapi ob odprtem ovalnem oknu zaenkrat ni poznan. Standardna metoda za ugotavljanje prehodnosti ovalnega okna je transezofagealna ehokardiografija, vendar je zaradi invazivnosti in dolgotrajnosti relativno slabo dostopna. Desno-levi šant lahko dokažemo tudi s transkranialnim doplerjem, ki je z uporabo kontrastnega sredstva in Valsalvinega manevra občutljiva presejalna metoda za bolnike z odprtim ovalnim oknom. Občutljivost metode je med 91 in 100%, specifičnost metode pa 94%. Pri bolnikih s kriptogeno ishemično možgansko kapjo in pozitivnim izvidom transkranialne doplerske sonografije je indicirana antiagregacijska zaščita in nadaljnja diagnostična obravnava s transezofagealno ehokardiografijo. V primeru negativnega izvida lahko z veliko verjetnostjo izključimo desno-levi šant in s tem odprto ovalno okno. Metoda lahko zaradi visoke specifičnosti in občutljivosti služi kot dober presajalni test za odkrivanje desno-levih srčnih šantov.
Descriptors		CEREBRAL ISCHEMIA CEREBRAL INFARCTION ULTRASONOGRAPHY, DOPPLER, TRANSCRANIAL HEART SEPTAL DEFECTS