Journal Mobile Options
Table of Contents
Vol. 37, No. 1, 2011
Issue release date: September 2011
Neuroepidemiology 2011;37:64–71
(DOI:10.1159/000327757)

Estimated Prevalence of Acoustic Cranial Windows and Intracranial Stenosis in the US Elderly Population: Ultrasound Screening in Adults for Intracranial Disease Study

Suri M.F.K. · Georgiadis A.L. · Tariq N. · Vazquez G. · Qureshi N. · Qureshi A.I.
Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minn., USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background: Intracranial atherosclerosis is an important etiology of stroke in the USA, but its prevalence in the general population remains unknown. This study was performed to determine the feasibility of transcranial Doppler ultrasound (TCD) for general population screening and to estimate the prevalence of intracranial stenosis in the USA. Methods: We used a public database to randomly select 99 subjects aged 65–84 years residing in a well-defined geographic area. For all subjects clinical history was reviewed, blood pressure was recorded and TCD examination was performed to identify intracranial stenosis. Results: The mean age of subjects was 72 years, 42 were men, and 17 were African-Americans. All acoustic windows were present in 77 subjects. After multivariate adjustment, the odds of absence of a bone window were higher in African-Americans [odds ratio (OR) 6.0, 95% confidence interval (CI) 1.8–2.0], nonsmokers (OR 3.1, 95% CI 1.0–9) and those with a high BMI (9% higher odds per index point). Among 77 subjects who had all acoustic windows present, intracranial stenosis of >50% was identified in 6.5%, and intracranial stenosis of any severity was identified in 16% of the persons. Intracranial stenosis was most prevalent in the middle cerebral artery (6%). Conclusion: Presence of acoustic windows is associated with vascular risk factors. Based on the high prevalence of significant intracranial stenosis in the US elderly population, it is feasible and important to perform a large-scale population-based study for this disease entity.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Chimowitz MI, Lynn MJ, Howlett-Smith H, et al: Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 2005;352:1305–1316.
  2. Sacco RL, Kargman DE, Gu Q, Zamanillo MC: Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 1995;26:14–20.
  3. Kasner SE, Chimowitz MI, Lynn MJ, et al: Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation 2006;113:555–563.
  4. Lloyd-Jones D, Adams R, Carnethon M, et al: Heart disease and stroke statistics – 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009;119:480–486.
  5. Qureshi AI, Feldmann E, Gomez CR, et al: Consensus conference on intracranial atherosclerotic disease: rationale, methodology, and results. J Neuroimaging 2009;19(suppl 1):1S–10S.
  6. Greenland P, Smith SCJ, Grundy SM: Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests. Circulation 2001;104:1863–1867.
  7. Smith SCJ, Greenland P, Grundy SM: AHA Conference Proceedings. Prevention conference V: beyond secondary prevention: identifying the high-risk patient for primary prevention: executive summary. American Heart Association. Circulation 2000;101:111–116.
  8. Wong KS, Huang YN, Yang HB, et al: A door-to-door survey of intracranial atherosclerosis in Liangbei County, China. Neurology 2007;68:2031–2034.
  9. Huang HW, Guo MH, Lin RJ, et al: Prevalence and risk factors of middle cerebral artery stenosis in asymptomatic residents in Rongqi County, Guangdong. Cerebrovasc Dis 2007;24:111–115.
  10. Feldmann E, Wilterdink JL, Kosinski A, et al: The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial. Neurology 2007;68:2099–2106.
  11. Hashimoto H, Etani H, Naka M, Kinoshita N, Nukada T: Assessment of the rate of successful transcranial Doppler recording through the temporal windows in Japanese with special reference to aging and sex (in Japanese). Nippon Ronen Igakkai Zasshi 1992;29:119–122.
  12. Itoh T, Matsumoto M, Handa N, et al: Rate of successful recording of blood flow signals in the middle cerebral artery using transcranial Doppler sonography. Stroke 1993;24:1192–1195.
  13. Seidel G, Kaps M, Gerriets T: Potential and limitations of transcranial color-coded sonography in stroke patients. Stroke 1995;26:2061–2066.
  14. Gahn G, Gerber J, Hallmeyer S, et al: Contrast-enhanced transcranial color-coded duplexsonography in stroke patients with limited bone windows. AJNR Am J Neuroradiol 2000;21:509–514.
  15. Marinoni M, Ginanneschi A, Forleo P, Amaducci L: Technical limits in transcranial Doppler recording: inadequate acoustic windows. Ultrasound Med Biol 1997;23:1275–1277.
  16. Krejza J, Swiat M, Pawlak MA, et al: Suitability of temporal bone acoustic window: conventional TCD versus transcranial color-coded duplex sonography. J Neuroimaging 2007;17:311–314.
  17. Yagita Y, Etani H, Handa N, et al: Effect of transcranial Doppler intensity on successful recording in Japanese patients. Ultrasound Med Biol 1996;22:701–705.
  18. Kwon JH, Kim JS, Kang DW, Bae KS, Kwon SU: The thickness and texture of temporal bone in brain CT predict acoustic window failure of transcranial Doppler. J Neuroimaging 2006;16:347–352.

    External Resources

  19. Wijnhoud AD, Franckena M, van der Lugt A, Koudstaal PJ, Dippel ED: Inadequate acoustical temporal bone window in patients with a transient ischemic attack or minor stroke: role of skull thickness and bone density. Ultrasound Med Biol 2008;34:923–929.
  20. Jarquin-Valdivia AA, McCartney J, Palestrant D, et al: The thickness of the temporal squama and its implication for transcranial sonography. J Neuroimaging 2004;14:139–142.
  21. Kollar J, Schulte-Altedorneburg G, Sikula J, et al: Image quality of the temporal bone window examined by transcranial Doppler sonography and correlation with postmortem computed tomography measurements. Cerebrovasc Dis 2004;17:61–65.
  22. Hatipoglu HG, Ozcan HN, Hatipoglu US, Yuksel E: Age, sex and body mass index in relation to calvarial diploë thickness and craniometric data on MRI. Forensic Sci Int 2008;182:46–51.

    External Resources

  23. Lorentzon M, Mellstrom D, Haug E, Ohlsson C: Smoking is associated with lower bone mineral density and reduced cortical thickness in young men. J Clin Endocrinol Metab 2007;92:497–503.
  24. Tang S-C, Jeng J-S, Yip P-K, et al: Transcranial color-coded sonography for the detection of middle cerebral artery stenosis. J Ultrasound Med 2005;24:451–457.
  25. Zunker P, Wilms H, Brossmann J, et al: Echo contrast-enhanced transcranial ultrasound: frequency of use, diagnostic benefit, and validity of results compared with MRA. Stroke 2002;33:2600–2603.
  26. White PM, Wardlaw JM, Teasdale E, et al: Power transcranial Doppler ultrasound in the detection of intracranial aneurysms. Stroke 2001;32:1291–1297.
  27. Baumgartner RW, Mattle HP, Schroth G: Assessment of ≧50% and <50% intracranial stenoses by transcranial color-coded duplex sonography. Stroke 1999;30:87–92.
  28. Postert T, Braun B, Meves S, et al: Contrast-enhanced transcranial color-coded sonography in acute hemispheric brain infarction. Stroke 1999;30:1819–1826.
  29. Kenton AR, Martin PJ, Abbott RJ, Moody AR: Comparison of transcranial color-coded sonography and magnetic resonance angiography in acute stroke. Stroke 1997;28:1601–1606.
  30. Baker AB, Resch JA: Studies on cerebral arteriosclerosis (in Spanish). Prensa Med Argent 1966;53:99–103.
  31. Flora GC, Baker AB, Klassen A: Age and cerebral atherosclerosis. J Neurol Sci 1968;6:357–372.
  32. Flora GC, Baker AB, Loewenson RB, Klassen AC: A comparative study of cerebral atherosclerosis in males and females. Circulation 1968;38:859–869.
  33. Baker AB, Resch JA, Loewenson RB: Hypertension and cerebral atherosclerosis. Circulation 1969;39:701–710.
  34. McGarry P, Solberg LA, Guzman MA, Strong JP: Cerebral atherosclerosis in New Orleans: comparisons of lesions by age, sex, and race. Lab Invest 1985;52:533–539.
  35. Leung SY, Ng TH, Yuen ST, Lauder IJ, Ho FC: Pattern of cerebral atherosclerosis in Hong Kong Chinese: severity in intracranial and extracranial vessels. Stroke 1993;24:779–786.
  36. Wong KS, Huang YN, Gao S, et al: Intracranial stenosis in Chinese patients with acute stroke. Neurology 1998;50:812–813.
  37. Wong KS, Li H, Chan YL, et al: Use of transcranial Doppler ultrasound to predict outcome in patients with intracranial large-artery occlusive disease. Stroke 2000;31:2641–2647.
  38. Elmore EM, Mosquera A, Weinberger J: The prevalence of asymptomatic intracranial large-vessel occlusive disease: the role of diabetes. J Neuroimaging 2003;13:224–227.
  39. Uehara T, Tabuchi M, Mori E: Risk factors for occlusive lesions of intracranial arteries in stroke-free Japanese. Eur J Neurol 2005; 12:218–222.
  40. Adams R, McKie V, Nichols F, et al: The use of transcranial ultrasonography to predict stroke in sickle cell disease. N Engl J Med 1992;326:605–610.
  41. Adams RJ, McKie VC, Hsu L, et al: Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med 1998;339:5–11.
  42. Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) Trial Investigators: Stroke Outcome and Neuroimaging of Intracranial Atherosclerosis (SONIA): design of a prospective, multicenter trial of diagnostic tests. Neuroepidemiology 2004;23:23–32.

    External Resources

  43. Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial Investigators: Design, progress and challenges of a double-blind trial of warfarin versus aspirin for symptomatic intracranial arterial stenosis. Neuroepidemiology 2003;22:106–117.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50