Neurosonology in acute stroke revealing bilateral internal carotid artery occlusion maintained by persistent embryologic collaterals: A case report

Neurosonology has become a pivotal modality in acute and subacute neurovascular assessment, providing rapid, non-invasive evaluation of arterial patency and cerebral hemodynamics. We report the case of a 49-year-old woman, active smoker, who presented with transient dysarthria and right brachio-facial weakness, leaving only mild residual dysarthria on admission. Brain MRI demonstrated a superficial infarction within the left middle cerebral artery territory. Extracranial duplex ultrasound played a decisive diagnostic role by revealing bilateral internal carotid artery occlusion and suggesting the presence of compensatory collateral circulation. These findings were subsequently corroborated by vascular imaging. The patient was managed with antithrombotic therapy, with favorable radiological evolution characterized by reperfusion of the previously occluded carotid axis. This observation underscores the fundamental contribution of neurosonology not only for early identification of major arterial occlusion, but also for functional assessment of flow dynamics and collateral supply. It reinforces duplex ultrasound as an indispensable component of comprehensive neurovascular work-up and a powerful complement to advanced angiographic modalities.