Neurosonology

Transcranial Color-Coded Duplex in Acute Encephalitis: Current Status and Future Prospects

Kargiotis et al. present their preliminary observations of consecutive ultrasound evaluations in 2 patients with acute encephalitis (presenting with aphasia and confusion), while they also review the possible diagnostic role of TCCD in such cases. 

Kargiotis O, Safouris A, Magoufis G, Stamboulis E, Tsivgoulis G. J Neuroimaging. 2016 May 12. doi: 10.1111/jon.12353

http://www.ncbi.nlm.nih.gov/pubmed/27171686

Kargiotis et al. present their preliminary observations of consecutive ultrasound evaluations in 2 patients with acute encephalitis (presenting with aphasia and confusion), while they also review the possible diagnostic role of TCCD in such cases.

The authors documented in both cases the following triad of abnormal findings during serial TCCD evaluations: (i) elevated pulsatility index (PI) in the left middle cerebral artery (M1 MCA) at baseline (>1.2), (ii) increased PI in left M1 MCA by >25% in comparison to right M1 MCA, and (iii) decrease in PI in left M1 MCA by >25% at the follow-up evaluation at 48 hours. In addition, the authors documented a decrease in PI in left M1 MCA coincided with symptom improvement in both patients. The authors attributed the haemodynamic changes to focally increased intracranial pressure or peripheral vasospasm of distal left MCA branches.

The main take-home message of this study is that TCCD may add important diagnostic information on the haemodynamic changes during acute encephalitis. An improvement of the pathological haemodynamic changes documented during serial TCCD may be associated with symptom improvement.