[Value of a neurologic assessment when faced with the discovery of a cervical lesion using the Doppler method]

Four situations are envisaged for which a Doppler "unravelling" examination in a patient with arteritis, conducted on a routine basis, led to the detection of stenotic or occlusive lesions of neck vessels. The first case concerns a patient with a recent or long-standing permanent neurological disorder related to an established cerebral lesion. Once the latter has been confirmed as being due to the cervical lesion then angiography is not always essential, since treatment of an established vascular accident is usually ineffective. The second case involves asymptomatic patients with a history indicative of one or more transient episodes suggestive of carotid or vertebro-basilar insufficiency. This situation is the one where most benefit can be obtained from future investigations. The case of a patient with "cerebral circulatory insufficiency" is discussed ant the different clinical pictures produced outlined, while emphasizing that this term should not be used too easily for all presenile intellectual deterioration states. Finally, the last situation is that of an asymptomatic patient (rarely referred to the neurologist for an opinion): various topoghraphic, clinical and paraclinical factors must then be assessed before deciding to continue or not with investigations.