An 80-year-old man was admitted to our hospital with disturbance of consciousness, and complained of bilateral aggravated visual acuity 10 days after admission. Carotid Doppler ultrasonography showed stenosis of bilateral cervical internal carotid arteries. Transcranial color flow imaging demonstrated reversed flow at markedly decreased velocities in the left ophthalmic artery (OA) and bilateral middle cerebral arteries (MCA). Ocular ischemic syndrome was diagnosed. Percutaneous carotid artery stenting (CAS) was performed for bilateral carotid artery stenosis. After this procedure, stenosis of bilateral carotid arteries improved and OA flow became antegrade. Blood flow velocity in the OA and MCA was increased. However, visual acuity remained unimproved. Neurosonological examination is noninvasive and useful for evaluating cerebral blood flow and ocular ischemia, particularly when clinical improvement is insufficient after CAS.
