Deterioration of Doppler-derived anterior cerebral artery flow velocities has been described in newborns with evidence of brain death (Ann. Neurol. 14:302-307, 1983). Since these changes suggest a progressive decrease in cerebral perfusion, we correlated sequential Doppler flow velocities with technetium cerebral angiograms in 2 asphyxiated neonates.Case 1 was a 3800 gram term baby who developed lethargy and seizures within 24 hrs. of a difficult delivery. CT scan revealed cerebral edema and small subdural hemorrhage. Doppler flow studies (Medasonics D-10, 5 MHz probe) performed on day 3 showed retrograde diastolic flow. Peak systolic flow diminished on day 4. A technetium angiogram on day 4 showed markedly diminished cerebral perfusion and repeat study on day 9 after loss of all brainstem functions showed absence of intracranial circulation. Case 2 was a 3400 gram baby with severe birth asphyxia and seizures. CT scan revealed small ventricles and subarachnoid hemorrhage. Doppler flows were normal on day 1. Over the next 4 days, diastolic flow reversed and peak systolic flow diminished. Technetium study on day 6 showed absence of intracranial flow. Both patients expired.These patients confirm the earlier association between a deterioration of Doppler flow velocities and clinical evidence of brain death. Lack of cerebral perfusion was documented with technetium angiograms.