Abstract
Transcranial color-coded duplex sonography (TCCS) is a noninvasive modality that enables real-time evaluation of intracranial vasculature. In this report, we describe the bedside visualization of moyamoya vessels in a patient with established moyamoya disease using TCCS in combination with magnetic resonance angiography (MRA), highlighting the potential role of this approach in the detection of pathological collateral vessels. A 62-year-old woman with known moyamoya disease presented with acute impaired consciousness. MRA revealed bilateral terminal internal carotid artery (ICA) occlusion and prominent collateral vessel formation. TCCS demonstrated abnormal mosaic color flow in the middle cerebral artery (MCA) territory. The abnormal vascular signals observed with TCCS corresponded closely with the collateral network identified by MRA, supporting the concordance between these modalities. In this rare context of a postoperative bone defect created by prior right superficial temporal artery (STA) to MCA bypass surgery, TCCS enabled unusually detailed visualization of moyamoya vessels that corresponded closely with MRA findings. This case highlights the specific value of TCCS when a bone window is present, offering complementary diagnostic information that is not typically achievable in standard settings. This approach may serve as a valuable adjunct to conventional imaging in the evaluation and monitoring of moyamoya disease, particularly in clinical settings where bedside assessment is required.