Name of the Procedure:

Transcranial Doppler Study of the Intracranial Arteries; Emboli Detection with Intravenous Microbubble Injection

• Common Name: Transcranial Doppler Ultrasound with Microbubble Contrast

Summary

A Transcranial Doppler study with microbubble injection is a non-invasive test that uses ultrasound waves to assess blood flow in the brain's arteries and detect emboli (blood clots or air bubbles). It involves injecting microbubbles into a vein to enhance image quality and identify any issues in cerebral blood flow.

Purpose

The purpose of this procedure is to evaluate the blood flow in the brain's arteries and detect the presence of emboli. This can help diagnose potential sources of stroke or other vascular conditions affecting the brain.

Indications

• Symptoms of stroke or transient ischemic attack (TIA)
• Suspected cerebral embolism
• Monitoring for emboli during certain heart procedures
• Patients with a history of heart valve disease or recent cardiac surgery

Preparation

• Patients may be asked to avoid eating or drinking (fasting) for a few hours before the procedure.
• Patients should inform their healthcare provider of all medications they are taking, as some may need to be adjusted.
• Diagnostic tests like blood tests or other imaging studies may be required beforehand.

Procedure Description

1. The patient lies down on an examination table.
2. A healthcare provider applies a special gel to the patient's scalp to help transmit ultrasound waves.
3. An ultrasound probe is placed against the scalp to visualize the brain's arteries.
4. Microbubbles are then injected into a vein, typically in the arm.
5. The ultrasound probe detects the enhanced blood flow and identifies any emboli present.
6. The procedure is usually comfortable and requires no anesthesia.

Duration

The procedure typically takes about 30-60 minutes.

Setting

The procedure is performed in a hospital, outpatient clinic, or specialized diagnostic center.

Personnel

• Neurologist or radiologist
• Sonographer or ultrasound technician
• Nurse (for microbubble injection)

Risks and Complications

• Mild discomfort at the injection site
• Rare allergic reactions to the contrast agent
• Risk of dislodging an existing embolus (very rare)
• No radiation exposure as it uses ultrasound

Benefits

• Non-invasive with no need for surgery
• Provides valuable information about blood flow in the brain
• Can help prevent strokes by detecting emboli early
• Immediate results in many cases

Recovery

• Patients can usually return to normal activities immediately after the procedure.
• There may be minor swelling or bruising at the injection site.
• Follow-up appointments may be scheduled to discuss the results.

Alternatives

• CT or MRI angiography: Provides detailed images but involves radiation or magnetic fields.
• Carotid ultrasound: Focuses on blood flow in the neck arteries, might not give complete information about intracranial arteries.
• Digital subtraction angiography (DSA): More invasive but highly detailed.

Patient Experience

• Most patients feel only minor discomfort from the gel or probe pressure.
• The microbubble injection may cause a slight cold sensation.
• Pain management is not typically required, but any concerns should be discussed with the healthcare provider beforehand.