Prevention of cerebrovascular disease starts with ultrasonography of brain and neck vessels

Author: Jia Lingyun, Chief Physician, Xuanwu Hospital, Capital Medical University

Reviewer: Chief Physician of Huayang Capital Medical University Xuanwu Hospital

For patients with cerebrovascular diseases, doctors will recommend them to undergo brain-neck vascular ultrasound examination. In clinical work, this examination has become the preferred method for screening brain-neck vascular diseases.

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1. Ultrasound examination of brain and neck vessels and its role

Brain-neck vascular ultrasound is the ultrasound of the brain and neck blood vessels, referred to as brain-neck vascular ultrasound, which uses ultrasound imaging technology to examine intracranial blood vessels and neck blood vessels. It is characterized by being non-invasive, convenient, economical, and repeatable.

The role of brain-cervical vascular ultrasound in the diagnosis, treatment and follow-up of stroke is becoming increasingly apparent. At the same time, as an important means of early screening and diagnosis and treatment evaluation of high-risk groups for stroke, it is also one of the appropriate technologies for stroke prevention and treatment, and is therefore widely used in clinical practice.

The widespread application of brain-cervical vascular ultrasound examination is not only conducive to expanding the clinical application scope of carotid artery ultrasound and transcranial Doppler ultrasound and improving their clinical application value, but also helps to conduct preoperative screening, accurate evaluation and postoperative follow-up of high-risk groups.

2. Purpose and target population of brain-carotid artery ultrasound examination

An important part of the cerebral-carotid ultrasound examination is the cerebral-carotid artery ultrasound examination, and the main purpose of the cerebral-carotid artery ultrasound examination is to detect whether there are stenosis and occlusive lesions in the intracranial arteries and the neck arteries, and to evaluate the compensation of the vascular collateral circulation. The purpose of the examination is different for patients with cerebrovascular diseases at different stages.

① Early screening of cerebrovascular disease is conducive to the discovery of lesions and facilitates early treatment.

② For people with risk factors for cerebrovascular disease, such as hypertension, diabetes, hyperlipidemia, coronary heart disease, overweight, long-term smoking and a history of stroke, screening for brain-cervical atherosclerotic lesions should be performed to facilitate early detection and treatment.

③For patients who have been screened to have cerebral-cervical vascular stenosis or occlusive lesions, follow-up examinations can be carried out to observe the effectiveness of treatment in a timely manner.

④For patients who are about to undergo surgical treatment, brain-carotid artery ultrasound examination can provide a comprehensive preoperative evaluation and provide clinically relevant objective information related to diagnosis and treatment.

⑤ If the patient is undergoing carotid endarterectomy, performing brain-carotid artery ultrasound examination during the operation can help monitor the patient's safety and protect his life.

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So, when performing brain-carotid vascular ultrasound examination, which patients need to undergo brain-carotid artery ultrasound examination in a timely manner?

1. Patients with obvious symptoms

① One side of the upper or lower limb feels numb and weak, and speech is unclear.

② Visual abnormalities. Temporary blindness (also known as transient blindness) or complete monocular blindness due to some reason.

③ Dizziness, nausea, vomiting, unsteady walking and inability to walk in a straight line, difficulty swallowing or choking, etc.

④ Syncope: Fainting or falling suddenly for unknown reasons, with temporary unconsciousness.

⑤ Asymmetric pulses in both upper limbs.

2. Patients without obvious symptoms

Studies have shown that the prevalence of asymptomatic carotid stenosis is 2% to 18%. Therefore, patients over 40 years old with three or more risk factors (including hypertension, hyperlipidemia, coronary heart disease, smoking, long-term lack of exercise, overweight, etc.) should undergo brain-carotid artery ultrasound examination.

3. Young people with related symptoms

Young people have a lower risk of cerebrovascular disease than the elderly. If there are no symptoms, there is no need to undergo routine cerebral-carotid ultrasound examinations. However, the results of epidemiological surveys on cerebrovascular diseases show that the incidence of stroke tends to be younger. In addition, young people have some particularities in the etiology of stroke compared to the elderly. Therefore, if young people have related symptoms of cerebral ischemia, such as numbness and weakness of one limb, slurred speech, double vision, transient monocular blindness, dizziness, etc., they need to be checked in time to determine whether there is cerebrovascular disease as soon as possible.

3. What preparations should be made before the brain-cervical vascular ultrasound examination?

Patients should make relevant preparations before undergoing brain-cervical vascular ultrasound examination.

① Bring previous imaging examination data, including head computed tomography, magnetic resonance imaging, angiography, etc. Provide the doctor with the relevant medical history and duration of previous stroke in advance.

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② Make personal preparations. Before the examination, patients should avoid applying makeup on their face, eyelids, and tragus, remove neck decorations, and try not to wear high-necked clothes.

③ Eat normally and drink water in moderation to avoid reducing the blood flow velocity in the brain due to blood viscosity, which may affect the accuracy of the test results. Elderly patients should pay more attention to this.

Although ultrasound examination of brain and neck vessels can detect early symptoms of stroke so that timely treatment measures can be taken, daily prevention of patients is more important. The goal of preventing cerebrovascular diseases should be achieved by changing unhealthy lifestyle behaviors and irregular living habits.

References

[1] Yang Jing, Song Linzi, Hua Yang. Practice and thinking on integrated ultrasound assessment of brain-cervical vascular to promote the construction of stroke center[J]. China Medical Herald, 2021, 18(36): 193-196.