Article Figures & Data
Figures
- 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).
- 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).
Tables
Location of Musical Murmurs Severe Stenosis (n = 58)* Collaterals (n = 5) C-C Fistula (n = 2) Moyamoya Disease (n = 1) Extracranial (n = 4) Internal carotid artery 3 Vertebral artery 1 Intracranial (n = 62) Retro-orbital area 1† 2 Terminal internal carotid artery 2 Middle cerebral artery 20 1 Anterior cerebral artery 9 Posterior cerebral artery 13 Anterior communicating artery 5‡ Vertebral artery 5 Basilar artery 4 Note:—C-C fistula indicates carotid cavernous sinus fistula.
* Number of musical murmurs.
† Transmitted from stenotic terminal internal carotid artery.
‡ Were grouped into anterior cerebral artery by sonographic findings.
- TABLE 2:
Clinical features and risk factors of 57 patients with musical murmurs due to stenotic vascular lesion
Clinical Presentation Transient Ischemic Attack Infarct Dizziness, Vertigo, and Faintness Total No. of patients 9 41 7 57 Risk factors Hypertension 8 34 6 48 Old age (>65 y) 6 21 7 34 Diabetes mellitus 2 16 4 22 Smoking 5 12 2 19 Hyperlipidemia 3 11 3 17 Ischemic heart disease 1 7 4 12 Previous stroke 0 9 0 9 Previous transient ischemic attack 1 1 0 2
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