Neurosonographie an der Stroke Unit – ein Update

The use of neurosonography is an essential component of routine evaluation after ischemic stroke. As a straightforward bedside examination, it can be performed directly in the emergency room or stroke unit, with three important areas of application to mention: 1) Occlusive processes of brain-supplying vessels: in addition to detecting high-grade stenoses and occlusions, ultrasound is highly suitable for assessing the surface and echogenicity of atherosclerotic plaques in the brain-supplying vessels. This allows for the identification of high-risk plaques that, regardless of the degree of stenosis, are associated with the occurrence of strokes. 2) Cerebral hemodynamics after vessel recanalization: mechanical thrombectomy has significantly improved outcomes of stroke patients with large vessel occlusions. However, about one-third of these patients show alterations in cerebral hemodynamics. A notable example is hyperperfusion syndrome, which is linked to an increased risk of hemorrhagic transformation. The use of transcranial ultrasound enables the early detection of such changes, which can be considered in an individualized treatment approach. 3) Right-to-left shunt diagnostics: in patients under 60 years old with cortical infarctions and no abnormalities in routine evaluation, the presence of a right-to-left shunt, such as a patent foramen ovale, should be evaluated. Transcranial ultrasound, with its high sensitivity, serves as an excellent screening tool for diagnosing right-to-left shunts.