Ultrasound during neck rotation to reveal a case of positional occlusion of the internal carotid artery

Positional occlusion of the internal carotid artery is an unusual phenomenon. Reports are scarce in the literature and generally related to compression by external agents when the head is rotated. Cases with no extrinsic etiology are even more uncommon and require high suspicion to avoid misdiagnosis. We present a case of a patient with intermittent internal carotid occlusion depending on the position of the head with no external agent identified. Due to the dynamic characteristics of this presentation, diagnostic tests yielded contradictory results. Carotid ultrasound during neck rotation revealed the positional occlusion. Ultrasound is a versatile technique to explore the carotid arteries in different angles of the neck, useful if positional pathology is suspected.