The role of transcranial doppler in localizing stroke lesion: A valuable tool in low resource setting

The use of transcranial Doppler (TCD) ultrasound in acute cerebrovascular events has not been widely adopted although it can help clinicians make informed decisions in the early evaluation of patients. A 74-year-old female presented to the emergency department with an acute onset of weakness of the left upper and lower limbs, along with slurring of speech, for the last 12 hours. Non-contrast CT of the head showed a hypodense area in the right frontotemporal region, suggestive of cerebral oedema. A TCD study through the transtemporal window showed increased pulsatility index (PI) of right internal carotid artery and right middle cerebral artery when compared with a control subject. A contrast-enhanced magnetic resonance angiography showed findings consistent with those obtained with the TCD. The TCD clearly indicated the regional involvement in a patient who presented with stroke-like symptoms and, in resource-limited settings, may help in making early treatment decisions.