Hemodynamic assessment of cervical internal carotid artery stenosis during head manipulation: case report.

Positional intermittent carotid ischemia has rarely been reported in the literature. We report a case of fluctuating hemiparesis in a 88-year-old woman in whom transcranial Doppler ultrasonography at various head positions proved useful in establishing the mechanism of the hypoperfusion transient ischemic attack. Head rotation to the side of the stenotic internal carotid artery resulted in significant drop in ipsilateral middle cerebral artery mean flow velocity.