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Conventional methods of neuroimaging, such as computed tomography and magnetic resonance imaging, are mostly useful in exclusion of movement disorders with secondary aetiology. Recently, the application of transcranial sonography has been introduced to the diagnosis of extrapyramidal diseases. This valuable technique, with proven usefulness in the field of cerebrovascular events, may reveal some brain parenchymal structures. In this review the most important findings of ultrasonographic abnormalities in the brain, particularly hyperechogenicity of substantia nigra in Parkinson disease, are presented.

The aim of this study is to assess the treatment results in patients with cerebellar infarctions and attempt to determine the features influencing the results.We have analysed 12 patients with cerebellar infarctions treated from 1987 to 1996. The patients were admitted to hospital in the period between 24 hours and 37 days after onset. The level of consciousness on admission was assessed according to the Glasgow Coma Scale and results of treatment were assessed according to the Glasgow Outcome Scale at the time of discharge. The CT, MR, angio-MR, cerebral arteriography, USG-Doppler and ECHO were the main diagnostic methods. All patients were treated medically; temporary external ventricular drainage or ventriculoperitoneal shunt were used when hydrocephalus had been found. The influence of the level of consciousness, stroke localisation and presence of hydrocephalus on the results of treatment were analysed.2 patients were in coma on admission, 3 patients scored 13-14 points in GCS and 7 patients did not demonstrate any consciousness disturbances. On neurological examination patients showed cerebellar signs in 9 cases, hemiparesis in 4 cases, lower cranial nerve dysfunction in 3 cases, eyeball movement disorders, compulsory gaze deviation, hemihypoaesthesia, trigeminal nerve dysfunction, peripheral facial palsy in 2 cases each and deafness in 1 case. Infarctions were localised in the cerebellar hemisphere only in 7 cases, in the cerebellar hemisphere with vermian extension in 2 cases and in 3 cases in cerebellum with brain stem extension. Based on additional investigations atherosclerotic occlusion in 3 cases and embolism mechanism in 4 cases were found as causes of the stroke; in 5 cases the cause of stroke remained unknown. The hydrocephalus resulting from the obstruction of cerebrospinal flow pathways was found in 5 patients. 1 patient died, permanent neurological deficits (GOS: SD) were found in 2 patients, the treatment results were successful (GOS: MD + GR) in 9 patients. The infarctions with brain stem extension had the greatest influence on treatment results among all analysed features. The level of consciousness on admission and presence of hydrocephalus had less influence on treatment results.In all patients with consciousness disturbances the hydrocephalus was found. The stroke localisation had a great influence on treatment results: worst results were obtained in patients with infarcts extending onto the brain stem. The consciousness disturbances on admission and the presence of hydrocephalus had only a slight influence on the results of treatment.

Transcranial Doppler sonography (TCD) is a non-invasive method that can be repeated to measure blood flow velocity in intracranial arteries and to assess cerebrovascular reactivity in patients with a variety of neurological diseases. The aim of this study was Doppler sonography evaluation of blood flow and reactivity in the middle cerebral artery in patients at different stages after mild head injuries. The dynamic assessment of blood flow velocity and pulsatility index both at rest and after hyperventilation in 73 patients with mild head injuries was carried out on the day of injury, the third day, sixth day and after 6 months to 5 years. The control group consisted of 61 healthy volunteers. Obtained results indicate an increase in blood flow velocity in the middle cerebral artery on the day of injury and a decrease within the following days in younger patients (aged xleq 30 yrs). Also their cerebrovascular reactivity was significantly lower. In older persons (age30 yrs) and in patients with remotely suffered injuries, neither blood flow velocity in the middle cerebral arteries nor cerebrovascular reactivity differed significantly from the results of the respective age control groups. The findings justify a conclusion that mild head injury is followed by changes both in the blood flow and cerebrovascular reactivity. In younger patients with mild head injuries these haemodynamic disturbances seem to be connected with altered activity of the autonomic system.

In most people the left hemisphere of the brain is dominant for language functions. Because of an increased incidence of atypical language lateralisation in the right hemisphere of left-handed neurological patients, more systematic studies on handedness and cerebral asymmetry of language have been undertaken. The present study is aimed at clarification of the relationship between handedness and language dominance in healthy subjects. Lateralisation was measured directly using functional transcranial Doppler sonography in left-handed subjects. Twenty-six individuals participated in the study. Three kinds of tasks were used, differing in the material involved and in appropriate strategies to be employed by the subjects. Two important parameters of the MCA blood flow were analysed: mean relative increase in the blood flow velocity (MDV) and specific patterns of cognitive task performance (i.e. performance profiles). Our results indicate that the incidence of the right hemisphere dominance for language depends on the degree of handedness, since only in the group of consistent left-handers language was right lateralised. In other left-handers both cerebral hemispheres were functionally equivalent. The measurement of MCA blood flow velocity changes using transcranial Doppler ultrasonography seems to be a simple and non-invasive method of assessing the functioning of the two hemispheres of human brain.

Most recent studies on transcranial Doppler (TCD) in the acute phase of ischemic stroke are reviewed in this paper. TCD is a highly sensitive and specific method of quick, bedside assessment of cerebrovascular circulation hemodynamics in the acute phase of ischemic stroke. The following issues are discussed in the paper: a new classification of ultrasound pathological changes associated with intracranial arteries occlusion or stenosis, the frequency of spontaneous re-canalisation by TCD, a comparison of TCD results with findings obtained by means of other vascular imaging techniques (e.g. DSA, CTA and MRA), relationship between TCD baseline assessment of primary blood flow changes and thrombolysis efficacy (the so-called TIBI classification, Thrombolysis in Brain Ischemia), and prognostic significance of TCD in the acute ischemic stroke. Moreover, first clinical reports on an additive effect of TCD on thrombolytic therapy are presented. The main limitations of TCD include the lack of sufficient bone window in 5-15% of patients and the lack of sufficiently trained staff capable of performing the examination a 24 h duty, since results of the examination to a large degree depend on the examiner's skills.

Ischemic strokes occurring in patients with non-rheumatic atrial fibrillation (AF) are due to a variety mechanisms, and not necessarily to cardiogenic embolism. The aim of the study was to determine the role and prevalence of carotid artery disease in stroke patients with AF, as well as its influence on the stroke prognosis. 513 consecutive patients with ischemic stroke participated in the study. The diagnosis was based on the clinical examination, brain CT and Doppler ultrasonography. Risk factors and clinical data were collected prospectively according to the Stroke Data Bank NIH protocol. AF was diagnosed in 166 (32.4%) patients. Carotid artery stenosis45% was present in 104 (20.3%). AF and co-existing carotid stenosis was found in 27 (5.3%) cases. There were 16.2% patients with carotid stenosis in the group with AF. In all groups 87 patients died (30-day mortality rate: 17%). The highest mortality rate was noted in the group with co-existing AF and carotid artery stenosis (25.9%), followed by the groups with AF only (21.6%) and no changes (15.9%), with the lowest mortality in the group with only vascular changes, i.e. stenosis or occlusion (9.1%). The carotid stenosis group differed significantly both from patients with co-existing AF and carotid stenosis (p0.01) and from those with AF only (p0.05).

Patients with moderate and minor head injury were evaluated with transcranial Doppler ultrasonography (TCD) and the relationship was studied between traumatic vasospasm (TVSP) and hyperaemia and the patients' age, clinical state, head CT examination and long-term results of treatment. The group examined consisted of 45 patients. The results obtained in this group were compared with the results in the control group. TVSP was observed in about 20% while hyperaemia occurred in 25% of the cases. Traumatic vasospasm in transcranial Doppler ultrasonography was found to occur most often in the group of patients with subdural or intracerebral haematomas.

The aim of our study was to investigate the blood flow in middle cerebral arteries during the different forms of cognitive activity in dyslectic persons. Two group of subjects were tested. The first group consisted of 10 students with school difficulties, diagnosed neuropsychologically as having a particular form of dyslexia, i.e. dysgraphy or dysorthography. 6 of them were right lateralized and 4--left lateralized. The second contained 10 students without such problems. 7 of them were right lateralized and 3--left lateralized. We used four kinds of cognitive tasks, during which the blood flow velocity in MCA in left and right hemisphere was measured with the Transcranial Doppler method. The analysis of the results showed differences between the groups of blood flow velocity levels, without a difference in performance profile. The dysgraphic persons had significantly higher blood flow velocity in the right hemisphere compared to the reference group. The results suggest particularly important role of right hemisphere in dyslexic persons, which is consistent with results obtained by other authors. The analysis of lateralization showed that this factor influences significantly the blood flow velocity level--the left lateralized persons showed lower rise of blood flow velocity than the right lateralized, regardless of the kind of task and measured hemisphere.

Several types of cerebral blood flow disturbances, resulting from head trauma are discussed. Application of Transcranial Doppler Sonography in diagnosing of posttraumatic cerebral vasospasm and cerebral hyperaemia, increased intracranial pressure, autoregulation disturbances, and brain death is described. Clinical examples of isolated cerebral blood flow disturbances, and several types of their co-existence are given. Special attention was paid to the noninvasiveness, repetitiveness, and relative ease of use of the technique. Transcranial Doppler examination can be especially useful in diagnosis and monitoring of different cerebral blood flow disturbances, which is especially important in therapy of brain trauma patients.

Shy and Drager in 1960 first described a disease of adult onset characterized by the progressive development of autonomic deficits. The most frequent symptoms are related to orthostatic hypotension, impaired gastrointestinal motility, and urinary and sexual dysfunction. Recently the syndrome has been linked to other degenerative disorders like striatonigral degeneration and olivopontocerebellar atrophy. This combination of degenerative diseases has come to be known as multiple system atrophy (MSA). Shy-Drager disease is most often met in 5 and 6 decade in men and women equally. Apart from autonomic dysfunction symptoms we can find a combination of signs connected with lesions localized in different regions of brain and cord. However, hypertonic-akinetic syndrome is the most often met in patients as an additional symptom. According to this to make a differential diagnosis is often difficult and possible only after autopsy. We describe the case of 57 years old male patient who was admitted to our Clinic because of episodes of orthostatic hypotension, urinary incontinence, sexual impotence; and parkinsonism. In MRI there were changes described as degenerative localized in different parts of brain an cord. Treatment of hypertonic-akinetic syndrome with levodopa/carbidopa and agonists of dopamine receptors increased the frequency of hypotonic episodes. High level of sensitivity to antiparkinsonian drugs is well known feature found in patient with Shy-Drager disease.

The cerebral blood flow was studied by means of transcranial ultrasonographic recording in hemorrhagic strokes. In acute phase of stroke the diastolic and mean velocity was slowed down and the pulsation index PI and resistance index RI were increased. Following of the changes of these indices may be of prognostic importance.

The 6-years results are described of intraoperative ultrasonic imaging of the brain tumors and are compared with the results of preoperative computerized tomography. On the basis of 169 cases it was shown that the lesions well visible in preoperative CT (with or without contrast) were also well delineated in USG. In cases of presence in CT with or without contrast of extensive isodense or hypodense area, USG could localize in all patients the tumor with suggestion of its morphology. Intraoperative ultrasonic investigation is a valuable method supplementing preoperative diagnostic procedures, facilitating the localization of isomorphic tumors, reducing brain traumatization and making possible control of radical removal of the lesions.

A multifocal astrocytoma, an uncommon cerebral lesion is presented. This case is particularly interesting because it was diagnosed by peroperative ultrasound scan. The epidemiology and the diagnostic procedure for multifocal gliomas is discussed.

Transcranial Doppler ultrasonography (TCD) is the most useful method for evaluation of relative changes of cerebral blood flow. This features was used in the investigations measuring cerebrovascular reactivity for physiological and pathological impulses.

A case of a 55-year-old woman with anterior communicating artery aneurysm has been described. The aneurysm led to subarachnoid haemorrhage 8 years after ligation of the right internal carotid artery in order to turn off an aneurysm of this artery. Angiography showed the existence of collateral circulation through the arterial circle of the brain with haemodynamic disturbances, confirmed by Doppler ultrasonography. According to the views found in the literature these disturbances are considered the probable factor of initiation of the described aneurysm.

The preliminary studies on cerebral blood flow changes during neuropsychologic tests were carried out using transcranial Doppler sonography (TCD). The procedure with the standardized cerebral activation in order to obtain the control brain activity level was elaborated and tested. Blood flow velocity changes were measured during two groups of tests: linguistic with left dominant hemisphere and visual-spatial with right dominant hemisphere. Similar dynamics of blood flow changes was observed with all kinds of brain activation with the maximum velocity increase of 15-20%. The velocity measured in the dominant hemisphere was about 8-10% above the contralateral side. TCD seems to be complementary to the neuropsychologic tests useful especially in diagnosis of different types of dementia.

In 41 cases of vertigo without abnormalities in neurological examinations BAEP examination, specialistic otological examination, X-ray of the cervical spine were done. In most cases Doppler USG examination of the carotid and vertebral arteries and EEG and CT of the head were obtained. The most frequent abnormality in these examinations were changes in cervical spine found in 30 cases (90%) and in BAEP--36.5%. BAEP changes were most frequently found in patients with known factors for dizziness--41.2%, followed by those with CT changes--33.3%, cervical spine changes--28.6% and changes in USG of the arteries supplying the brain from the neck.

Cerebrovascular reactivity and cerebrovascular reserve were studied using transcranial Doppler sonography (TCD). Investigations were carried out in acute cases--8 patients with severe head injury within 5 days after trauma and in chronic cases with brain tissue defect (12 patients), and in cases with cerebral circulation insufficiency (15 patients). In acute cases the pCO2 cerebrovascular response was studied and in chronic cases cerebrovascular reserve was estimated using acetazolamide. TCD was found suitable for local vascular reactivity disturbances determination independently in three intracranial compartments--both hemispheres and infratentorial space. In patients with local brain tissue defect cerebrovascular reserve remained within normal range. In cerebral circulation insufficiency vascular reserve disturbances were limited to one compartment in cases with local vascular lesion they were found in all three compartments in cases with generalized atheromatosis.

Transcranial Doppler (TCD) studies are very useful for the evaluation of intracranial pressure changes. The most informative for the TCD increase diagnosis are the diastolic pressure decrease and increase of two computed indices: pulsatility index (PI) and resistance index (RI). Single measurements can be misleading and therefore, monitoring of neurosurgical intensive care patients is suggested. Additional information is provided by TCD studies in cerebral blood flow autoregulation tests. The usefulness of TCD in brain death diagnosis is discussed also.

The study was carried out in 122 patients treated for stroke and transient disturbances of cerebral circulation. The results were analysed and compared of blood flow investigations in extracranial arteries by Doppler ultrasonography, radioisotope angioscintigraphy and angiography for the assessment of their clinical value and usefulness. It was found that Doppler ultrasonography was of essential value in the evaluation of the state of the extracranial arteries and for establishing of indications to other studies. However, in cases of slight changes in the studied vessels its value was lower and the method should be regarded as complementary to angioscintigraphy and angiography.

In the light of own experiences the diagnostic possibilities are presented of using Doppler ultrasonography with transfontanellar projection in the diagnosis and differentiation of vascular changes. Colour Doppler USG makes possible recording and measurement of blood flow in the vessels and may be specially useful in cases of central nervous lesions. The paper is supplemented with a videographic record of Galen's vein aneurysm imaged by Doppler USG.

Anomalies in the internal carotid artery which cause disturbances in blood flow dynamics in this artery affect also the blood flow in the ophthalmic artery and its branches. The blood flow in the ophthalmic arteries is assessed by USG-D examination with or without compression test. The test provides information on the nature and direction of the blood flow in the ophthalmic artery as well as source of collateral circulation. Good results in the ultrasonic assessment are obtained by using combined study of blood flow in the ophthalmic artery branches with the compression test as well as by direct study of the internal carotid artery. The above conclusion was reached in view of a high - agreement between the results of ultrasonography and contrast methods.

Using computer tomography and echoencephalography 20 subjects with normal pattern of the lateral ventricles and 20 patients with dilatation of these ventricles were studied. The patients were hospitalized in the Neurology Department of the Vienna University. On CT scans the distance between the anterior horns and heads of the caudate nuclei, and cranial width were measured and appropriate indices were calculated. In Echo-EG the position of the temporal horn was established and the cerebral pallium index was calculated. It was found that different indices in CT examination differ in subjects with normal lateral ventricles and in patients with internal hydrocephalus. In cases of hydrocephalus the index of the caudate nucleus was greater and the index of the anterior horns was smaller. The per cent indices in these cases were higher than in subjects with normal ventricles. In the patients with hydrocephalus the index of cerebral pallium calculated from Echo-EG was greater than in subjects with normal ventricles. Both diagnostic methods are regarded as useful for evaluating internal hydrocephalus, especially since they are non-invasive.

The paper contains conclusions from a comparative evaluation of neurological, echoencephalographic, electroencephalographic and angiographic investigations in supratentorial cerebral gliomas. The results of the analysis were based on 55 cases and were related to the whole material as well as to various localization groups. The usefulness of A echoencephalography is discussed from the standpoint of possibility of indicating the cerebral hemisphere involved by the tumour and in comparision with the results of other investigations.

Rheoencephalographic, electroencephalographic and echoencephalographic investigations were carried out in 44 patients with chronic cerebral circulatory failure aged from 49 to 79 years, and in a control group of 20 subjects in similar age range. The results of REG investigations suggested impaired elasticity and increased tonus of vascular walls in patients with cerebral circulatory failure. In comparison with EEG and EchoEG and REG investigation seems to be a more useful method for estimating the state of cerebral circulation.

The authors describe a 37-year-old man suffering electric shock caused by high-voltage current 3 000 Volt. The shock caused a fall with severe craniocerebral injury with fracture of occipital squama and subacute epidural haematoma in the posterior cerebral fossa. The injury was associated with vascular disturbances of the brain and brain stem which caused difficulties in disclosing typical signs of epidural heaematoma. Good therapeutic effects were obtained not only by surgical intervention and also by intensive treatment with antioedematous agents and drugs improving cerebral circulation.