Pulsatile echoencephalography

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Abstract
The development of pulsatile echoencephalography as a new clinical tool in neurology is reviewed. This dynamic technique offers a safe, simple method for measuring intracranlal echo pulsations. Clinical reports have related increased amplitude of the midline echo to various pathologic states. These include hypertension, vascular headache, and local vascular anomalies. "Flutter" patterns have been reported in hydrocephalus and during the prodromal stage of an epileptic attack. Patients with intracranial mass lesions have been found to have measurable decreases in the rise time of the echo pulsation. Experimental evidence showing the importance of respiration to measurements of recorded intracranial pulsations is presented. During normal inspiration, the echo pulsation is shown to have a decreased amplitude and increased delay time. The converse is true during expiration. Breath holding abolishes these cyclic changes. Possible physiologic mechanisms underlying these effects are discussed. They are thought to be the result of both arterial and venous hemodynamic factors secondary to altered venous return during the respiratory cycle.

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