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Transcranial Doppler sonography (TCD) is like any new procedure practiced by enthusiasts, operator dependent and propeled more by fervor than proof.
All contributors agree on its advantages and limitations, including a 10% to 15% "window failure" in patients who cannot be insonated. Wechsler and Babikian advocate the use of TCD for the detection of intracranial stenosis, an unproven indication, as the basis for the use of anticoagulants, an unproven treatment.
Despite the title of the contribution by Bornstein and Norris, they seem more taken by the technique's potential than by its proven clinical value.
While the noninvasiveness, the repeatability, and the inexpensiveness of TCD are truly attractive, cerebrovascular disease is far too serious to base major therapeutic decisions on an unproven technique. We need more evidence not only about what can be done with TCD but what should be done with TCD.
Hachinski V. Transcranial Doppler. Arch Neurol. 1994;51(10):1059. doi:10.1001/archneur.1994.00540220107023
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