Clinical Relevance of Musical Murmurs in Color-Coded Carotid and Transcranial Duplex Sonographies
S.-K. Lina,
S.-J. Ryub,
Y.-J. Changb and
T.-H. Leeb
a Department of Neurology, Buddhist Xindian Tzu Chi General Hospital
b Department of Neurology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
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Fig. 1. A, Color-coded carotid duplex sonography reveals a tight stenotic internal carotid artery with concurrent musical murmurs (arrowheads) and markedly elevated turbulent flow velocities. Stenosis of the internal carotid artery is confirmed by digital subtraction cerebral angiography (arrow).
B, Transcranial color-coded duplex sonography (TCCS) shows musical murmurs (arrowhead) in the proximal portion of the M2 segment of the right middle cerebral artery. MR angiography shows a tight stenotic artery (arrow) at the corresponding artery.
C, TCCS discloses a color flash just below the bifurcation of the right anterior and middle cerebral arteries with continuous musical murmurs (arrowhead) sounding like a Chinese bamboo flute. Cerebral angiography shows a severe stenotic lesion at the right terminal internal carotid artery (arrow).
D, TCCS shows concurrence of turbulent systolic spindle and musical murmurs of the left middle cerebral artery. MR angiography shows a tight stenotic lesion (arrow) at the corresponding artery.
E and F, Transorbital detection of retro-orbital vessels in 2 patients with an angiography-proved carotid cavernous sinus fistula (right) show an abnormal color flash with musical murmurs (left).
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Fig. 2. A, Doppler detection of a stenotic posterior cerebral artery with a high velocity scale (0–300 cm/s) shows elevated flow velocity with musical murmurs (arrows) embedded in the lower velocity area near the baseline.
B, Proper adjustment of the Doppler velocity scale to a lower setting (±30 cm/s) clearly demonstrates the musical murmurs (arrowheads).
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