title: Embolic stroke by compression maneuver during transcranial Doppler sonography.
abstract: OBJECTIVE
  Embolic complications during ultrasound examinations are a rare cause of neurological deficits. The present case documents the occurrence of embolism by a nonobstructive compression maneuver during transcranial Doppler examination, resulting in a minor stroke.
  
  
  METHODS
  A 63-year-old man suffered from recurrent transient ischemic attacks. Duplex sonography showed a small echogenic plaque at the right carotid bifurcation. During transcranial Doppler studies with a reverberating compression maneuver of the right common carotid artery low in the neck, multiple emboli signals were detected, and the patient developed a left-sided hemiparesis with slurred speech. Funduscopy revealed cholesterol emboli in the inferior temporal arteriole of the right eye. These findings suggested embolization as the cause of the stroke.
  
  
  CONCLUSIONS
  Compression maneuvers should not be performed in patients with recent neurological symptoms, even in the case of only small lesions in the extracranial carotid territory.
authors.affiliation: Second Department of Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria.
authors.forename: N
authors.initials: N
authors.lastname: Khaffaf
authors.forename: R
authors.initials: R
authors.lastname: Karnik
authors.forename: W B
authors.initials: WB
authors.lastname: Winkler
authors.forename: A
authors.initials: A
authors.lastname: Valentin
authors.forename: J
authors.initials: J
authors.lastname: Slany
mesh_terms: D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000209:etiology*; D017700:Embolism, Cholesterol / Q000150:complications*; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging* / Q000601:surgery; D002542:Intracranial Embolism and Thrombosis / Q000150:complications*; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D017585:Ultrasonography, Doppler, Transcranial