The transcranial doppler appearance of acute carotid artery occlusion

Transcranial Doppler ultrasound is a noninvasive technique of cerebral blood velocity measurement that is being increasingly used to detect untoward hemodynamic changes. In this report, we describe striking transcranial Doppler ultrasound changes occurring in 2 patients after cervical carotid artery occlusion that led to cerebral infarction. These changes consist of the sudden appearance of a Doppler signal of extremely low pulsatility and moderately high velocity in the middle cerebral artery distribution. In 1 patient, this signal was the first sign of carotid occlusion. We suggest that these transcranial Doppler ultrasound changes can provide an early warning of carotid artery compromise.