Differentiation between intracerebral hemorrhage and ischemic stroke by transcranial duplex sonography.

Abstract

To the Editor: In their recent article,1 Maurer and colleagues concluded that (1) transcranial color-coded duplex sonography (TCCS) identified stroke complications and differentiated between intracerebral hemorrhage and ischemic stroke with reasonable sensitivity and specificity when compared to computed tomography (CT) of the brain, (2) TCCS may substitute for CT if CT service is not readily available, and (3) TCCS may be used to monitor stroke complications. I would raise the following comments. The differentiation between intracerebral hemorrhage and ischemic stroke has critical implications for stroke management because of the recent breakthrough in acute therapy of ischemic stroke with tissue plasminogen activator.2 3 4 A prior neuroimaging with CT or MRI is mandatory, because thrombolysis in intracerebral hemorrhage is definitely contraindicated and inappropriate.5 Differentiation between subtypes of ischemic stroke and determination of the underlying pathogenic mechanisms are not indicated in the acute stage because precious time should not be wasted.6 Signs of extensive infarction on neuroimaging would exclude the patient from receiving tissue plasminogen activator, since the risk of symptomatic hemorrhagic transformation would outweigh the potential benefit of revascularization.5 On the other hand, ongoing major clinical trials on …