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The Journal of the American Board of Family Medicine 20 (1): 65-71 (2007)
DOI: 10.3122/jabfm.2007.01.060128
© 2007 American Board of Family Medicine
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Evidence-Based Clinical Medicine

Transcranial Doppler: An Introduction for Primary Care Physicians

Mounzer Y. Kassab, MD, MA, Arshad Majid, MD, Muhammad U. Farooq, MD, Hend Azhary, MD, Linda A. Hershey, MD, Edward M. Bednarczyk, PharmD, Dion F. Graybeal, MD and Mark D. Johnson, MD

Department of Neurology and Ophthalmology (MYK, AM, MUF), Michigan State University, East Lansing, MI
Department of Family Practice (HA), State University of New York at Buffalo, NY
Department of Neurology (LAH), State University of New York at Buffalo, NY
Departments of Pharmacy Practice and Nuclear Medicine (EMB), State University of New York at Buffalo, NY
Department of Neurology (DFG, MD), University of Texas, Southwestern Medical Center, Dallas, TX

Correspondence: Corresponding author: Mounzer Y. Kassab, MD, 318 Service Road, A-217 Clinical Center, Michigan State University, East Lansing, MI 48824 (E-mail: mounzer.kassab{at}ht.msu.edu)

Transcranial Doppler (TCD) is a diagnostic tool that can be used at bedside to assess the cerebral vasculature noninvasively. It is inexpensive, safe, and reliable when compared with other techniques. It can be repeated multiple times and can be used for continuous monitoring if needed. Screening of children with sickle cell disease to assess and prevent ischemic strokes and monitoring for vasospasm after subarachnoid hemorrhage are well established, evidenced based utilizations of TCD. It is useful for the evaluation of occlusive intracranial vascular lesions with many emerging indications in the management of ischemic stroke. TCD with micro-bubble enhancement has comparable sensitivity to transesophageal echocardiogram in detecting right-to-left atrial cardiac shunts. TCD is underused as a clinical tool despite well established indications. The pressure to contain increasing medical cost will likely result in increased utilization of this test in future.




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