Sonographic findings in patients with superior sagittal sinus thrombosis were compared to those in healthy adults. Two patients with angiographically verified superior sagittal sinus thrombosis were examined by transcranial color-coded real-time sonography (TCCS) after intravenous application of a pulmonary stable ultrasound contrast agent. For comparison, 10 patients without venous pathology had contrast-enhanced TCCS; in addition, 30 healthy adults had plain TCCS to determine the identification rate for deep and superficial venous segments and to define normal values of venous blood flow velocities. The straight sinus was identified in 22 of 30 healthy subjects by plain TCCS, and in 9 of 10 patients by contrast-enhanced TCCS. The mean peak and angle-corrected blood flow velocity was 19.1 +/- 7.1 cm/sec. The superior and inferior sagittal sinuses were identified by contrast-enhanced TCCS in 2 and 1 subjects, respectively; they were never seen on plain TCCS. In the 2 patients with sagittal sinus thrombosis a distinct increase of blood flow velocity was recorded from the straight sinus (83 and 92 cm/sec), most likely reflecting collateral circulation. These preliminary data indicate that TCCS and particularly contrast-enhanced TCCS permit identification and blood flow measurements within the deep and occasionally, the superficial venous system. TCCS may contribute to an assessment of hemodynamic repercussions of venous thrombosis and may indicate the risk of venous infarction and hemorrhage.