Aims: To analyze the associated risk-factors, timing and early imaging findings in CAI.

Subjects: CIA was diagnosed in 30 infants using CUS and CDFI with the conventional scanning axes, and tangential planes1(to evaluate the cortical-subcortical regions). CDFI were done in 11 patients looking for differences between left and right middle cerebral artery (MCA)(color reduced or absent), both in coronal and tangential plane. The spectral analysis of the blood-flow velocity wave-form of the MCA was also analyzed in both sides (axial plane via temporal squama). Results: The main artery involved was the MCA (87%). Invasive procedures preceded the diagnosis of CAI in 17 patients. 27% of patients did not have any risk-factor preceding CAI. CAI was “silent” in 27%. Initial CUS was always diagnostic of CAI when performed at least 72 hours after the onset of symptoms, but was diagnostic in only 44% of the patients when performed in the first 72 hours after onset, although CDFI studies were always abnormal when the involved artery was the MCA. In 2 patients the CDFI changes antedated the changes in brain parenchymal echogenicity in 3 days. Conclusions: 1. Serial CUS is recommended in neonates who experience seizures or are at risk of stroke, because early scans can fail to show CAI. 2. CDFI allows early diagnosis of acute ischemic events leading to potential therapeutic approaches.