Related Experiment Video
Updated: Jun 23, 2026

Point of Care Transcranial Color-Coded Duplex Ultrasound of the Middle Cerebral Artery
Published on: August 9, 2024
TCD systolic spikes in a malignant MCA infarct
Jesus Perez-Nellar1, Claudio Scherle, Calixto Machado
1Hermanos Ameijeiras Hospital, Service of Neurology, Havana, Cuba. jesus.perez@infomed.sld.cu
Introduction:
Malignant MCA infarction results in significant space occupying effect and intracranial pressure (ICP) increment. Due to the high mortality rate in such patients, the term malignant MCA infarction was coined.
Methods:
We studied a patient who developed a sudden onset of slurred speech, right hemiplegia, and decreased level of arousal. Two days later CT scan showed a massive cerebral infarct, involving the left MCA territory.
Results:
A transcranial Doppler exam showed a normal flow pattern in the right hemisphere, but in the left hemisphere systolic spikes without diastolic flow were observed in internal carotid artery, anterior cerebral artery, as well as in the MCA.
Conclusions:
The pathophysiologic mechanisms leading to BD might asymmetrically begin in cerebral hemispheres in malignant MCA infarcts.
Related Concept Videos
Acute Coronary Syndrome I: Introduction
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
Acute Coronary Syndrome III: Diagnostic Studies
Cardiomyopathy III: Hypertrophic Cardiomyopathy
