Ethnic differences in the distribution of atherosclerosis in the brain-supplying vessels are well described . However, little is known regarding the distribution of atherosclerosis ; extracranial versus intracranial atherosclerotic carotid artery disease in Egyptian patients with stroke. Color-coded duplex sonography both Extracranial and Transcranial were used to evaluate the carotid arteries in a hospital-based study on 50 first-time Egyptian stroke patients. Egyptians were found to have both intracranial as well as extracranial significant atherosclerotic involvements of 10 % and 16 % , respectively . The stroke severity is significantly correlated with ESR . Extracranial atherosclerotic stenosis is significantly correlated with age , cholesterol level and smoking . Females showed more Transcranial insonation failure and more intracranial stenosis . The present study didn't disclose any isolated intracranial atherosclerotic lesion . Intracranial atherosclerotic stenosis is positively significantly correlated with fasting blood sugar .