Cerebral catheter angiography
X-rays taken after a radiopaque agent is injected via an intra-arterial catheter show individual cerebral arteries and venous structures of the brain. With digital data processing (digital subtraction angiography), small amounts of agent can produce high-resolution images.
Cerebral angiography supplements CT and MRI in delineating the site and vascularity of intracranial lesions; it has been the gold standard for diagnosing stenotic or occluded arteries, congenitally absent vessels, aneurysms, and arteriovenous malformations. Vessels, as small as 0.1 mm, can be visualized. However, its use has decreased dramatically with the advent of MRA and CT angiography. It is still routinely used when cerebral vasculitis is suspected and when angiographic interventions (eg, angioplasty, stent placement, intra-arterial thrombolysis, aneurysm obliteration) may be necessary.
Duplex Doppler ultrasonography
This noninvasive procedure can assess dissection, stenosis, occlusion, and ulceration of the carotid bifurcation. It is safe and rapid, but it does not provide the detail of angiography. It is preferable to periorbital Doppler ultrasonography and oculoplethysmography for evaluating patients with carotid artery transient ischemic attacks Transient Ischemic Attack (TIA) A transient ischemic attack (TIA) is focal brain ischemia that causes sudden, transient neurologic deficits and is not accompanied by permanent brain infarction (eg, negative results on diffusion-weighted... read more and is useful for following an abnormality over time.
Transcranial Doppler ultrasonography helps evaluate residual blood flow after brain death, vasospasm of the middle cerebral artery after subarachnoid hemorrhage, and vertebrobasilar stroke.
Ultrasonography can be used at the bedside (usually in the neonatal ICU) to detect hemorrhage and hydrocephalus Hydrocephalus Hydrocephalus is accumulation of excessive amounts of CSF, causing cerebral ventricular enlargement and/or increased intracranial pressure. Manifestations can include enlarged head, bulging... read more in children < 2 years.
CT has replaced echoencephalography in older children and adults.
X-rays are taken after a radiopaque contrast agent is injected into the subarachnoid space via lumbar puncture. MRI has replaced myelography for evaluation of intraspinal abnormalities, but CT myelography is still done when MRI is unavailable. CT myelography can provide more detailed images of the spinal cord and surrounding bone than MRI.
Contraindications Lumbar Puncture (Spinal Tap) Lumbar puncture is used to do the following: Evaluate intracranial pressure and cerebrospinal fluid (CSF) composition (see table Cerebrospinal Fluid Abnormalities in Various Disorders) Therapeutically... read more are the same as those for lumbar puncture.
Myelography may exacerbate the effects of spinal cord compression, especially if too much fluid is removed too rapidly. Rarely, myelography results in inflammation of the arachnoid membranes around the spinal nerves (arachnoiditis), which may cause chronic pain and paresthesias in the lower back and extremities.