Little information is available regarding alterations in regional cerebral blood flow and vascularity on cranial sonography in infants with focal ischemic brain injury. This study describes the use of color Doppler sonography in the characterization of these changes following acute neonatal stroke. Color Doppler examinations were performed as part of the series of clinically indicated cranial sonograms in eight infants with clinical, sonographic, and CT evidence of acute cerebral infarction. The cerebral vascularity of each hemisphere was assessed for symmetry and for presence of abnormal blood vessels. Initial Doppler study in four infants with hypoxic-ischemic infarcts showed increased size and number of visible vessels in the periphery of the infarct and increased mean blood flow velocity in vessels supplying or draining the infarcted areas. Diminished vessel number and size and frequency shifts suggestive of decreased hemispheric perfusion was identified in one infant with middle cerebral artery insufficiency. Repeat Doppler studies were performed on two infants. These showed the development of multiple small, irregular blood vessels in the periphery of the infarct. Focal abnormalities in regional cerebral blood flow may be present as part of the normal healing process following neonatal stroke, and can be demonstrated with color Doppler sonography.