Tuesday, October 28, 2008

Bruits and stroke exam minutiae

1. If at angle of jaw the stenosis is usually proximal ICA. If lower, its usually CCA or subclavian artery (with diaphragm)
2. Bruits that extend into diastole and are high pitched are invariably associated with tight stenotic lesions, ess than 1.5 mm.
3. Bruit over the contralateral eye (ocular) with bell can reflect carotid occlusion, due to increased contralateral flow, or stenosis of intracranial ipsilateral carotid artery.
Bruit can also be heard with cavernous carotid fistula. Pulsatile exopathlamos is seen in NF-I due to absent sphenoid bone. Palpable reduction of pulsation in the cca in the neck, in the eca in front of the ear, and in the ica in the lateral wall of the pharynx are not dependable signs and risk dislodging plaque material.
5. Central retinal artery pressure is reduced ipsilateral to a tight stenosis or occlusion which can be appreciated by gentle globe pressure while viewing the vessels from the optic nerve head.

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