Clinical relevance of musical murmurs in color-coded carotid and transcranial duplex sonographies.

Abstract

BACKGROUND AND PURPOSE:

Musical murmurs (MMs), sometimes called seagull cry, goose cry, honks, or cooing murmur, are murmurs with a single frequency that sounds like a musical tone. Doppler detections usually show mirror-image parallel strings or bands of low to moderate frequency. Musical murmurs are mostly described in cardiac murmurs and have seldom been mentioned in cerebrovascular disease.

METHODS:

A retrospective review of 12,000 patients from our neurosonographic data base of the past 7 years was conducted to find patients who had MMs during color-coded carotid and transcranial duplex sonographies.

RESULTS:

Sixty-six musical murmurs were found in 60 patients (0.5% of all studied patients). There were 44 men and 16 women with a mean age of 63.8 years. Musical murmurs may occur with or without simultaneous turbulent flows, or very close to a high-intensity frequency (with systolic spindles) turbulent flow. Musical murmurs are detected more frequently in intracranial vessels (94%) than in extracranial cervical arteries. The pathologic changes corresponding to the area of MMs were high-grade stenosis of the arteries (58 MMs), small arteries serving as collateral circulation (5 MMs), carotid cavernous sinus fistulas (2 MMs), and Moyamoya disease (1 MM). Fifty (88%) of 57 patients with stenotic arterial lesions had histories of cerebral infarction or transient ischemic attack, and 64% of the cerebrovascular events occurred on the side appropriate to the MMs.

CONCLUSIONS:

The presence of MMs in color-coded carotid duplex and transcranial color-coded duplex sonography imply severe underlying vascular diseases that require prompt treatment. Further cerebral angiographic study is warranted to clarify the underlying pathology in patients with MMs.

• Authors: S-K Lin, S-J Ryu, Y-J Chang, T-H Lee
• Journal: AJNR. American journal of neuroradiology (AJNR Am J Neuroradiol) Vol. 27 Issue 7 Pg. 1493-7 (Aug 2006) ISSN: 0195-6108 [Print] United States
• PMID: 16908566 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Carotid Artery Diseases (diagnostic imaging)
• Carotid Stenosis (diagnostic imaging)
• Carotid-Cavernous Sinus Fistula (diagnostic imaging)
• Cerebral Angiography
• Cerebral Arterial Diseases (diagnostic imaging)
• Cerebral Infarction (diagnostic imaging)
• Cerebrovascular Circulation (physiology)
• Collateral Circulation (physiology)
• Female
• Humans
• Ischemic Attack, Transient (diagnostic imaging)
• Male
• Middle Aged
• Moyamoya Disease (diagnostic imaging)
• Regional Blood Flow (physiology)
• Retrospective Studies
• Sound
• Ultrasonography, Doppler, Color (methods)
• Ultrasonography, Doppler, Transcranial (methods)