Importance of rapid ultrasonography in emergency department patients with preliminary diagnosis of ischemic cerebrovascular disease

Imaging methods in ischemic stroke are important. In this study, we aimed demonstrate the importance of rapid ultrasonography in the imaging of pathologies in patients with an ischemic stroke pre-existing emergency department. Patients with a preliminary diagnosis ischemic stroke that are above 18-years-of-age that applied to Hacettepe University Emergency Department during 01.07.2018 to 01.08.2018 are examined. Bed-side Ultrasonographies are performed by an emergency medicine senior resident. Demographics are gathered through patient records. Ultrasonographic studies are performed with physician-in-charge's permission to allow non-contrast computerized tomographies to be completed in a timely manner. Ultrasonographic evaluation consisted carotid, vertebral, transcranial doppler ultrasonography and echocardiography. Carotid artery doppler and TIBI classifications were used respectively for carotid artery and middle cerebral artery. Sonographic findings were compared to computerized tomography angiography findings. 45 patients were included in this prospective, observational study. Patients had a mean age of 66.71±16.49; 51.9% was male and 48.1% was female. Echocardiographic findings of patients with definitive diagnosis of ischemic stroke showed ejection fraction of <30% in 11.1%, intracardiac thrombus in 3.7% and wall motion abnormalities in 22.2%. In comparison to computerized tomography angiography sensitivities and specificities of Doppler ultrasound findings were 75% and 100% for critical stenosis or occlusion of carotid artery, 66.67% and 96.67% for occlusion of vertebral artery, 50% and 96.50% for occlusion of middle cerebral artery, respectively. This research suggests the importance of rapid ultrasonography to establish the diagnosis of ischemic stroke and to identify possible etiologies in the emergency department. There may be a need for new studies in larger patient groups. Keywords: Ischemic stroke, Doppler Ultrasound, Emergency Department.