Does This Patient Have a Clinically Important Carotid Bruit?
- Jean-Stéphane Sauvé., MD;
- Andreas Laupacis, MD;
- Truls Østbye, MD;
- Brian Feagan, MD;
- David L. Sackett, MD
- From the Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario (Drs Sauvé and Sackett); the Departments of Medicine and Epidemiology and Community Medicine, University of Ottawa (Ontario) (Dr Laupacis); the Departments of Epidemiology and Biostatistics and Family Medicine, University of Western Ontario, London (Dr Østbye); and the Department of Medicine, University of Western Ontario, London (Dr Feagan).
Since this article does not have an abstract, we have provided the first 150 words of the full text.
Excerpt
Case 1 A 50-year-old man undergoes a general physical examination for his insurance policy. A left-sided, focal, systolic carotid bruit is identified. There is no history of prior stroke or transient ischemic attack (TIA).
Case 2 A 50-year-old man undergoes a preoperative examination the evening before he is to undergo coronary bypass surgery. A bruit identical to that found in the first patient is heard. There is no history of cerebrovascular symptoms.
Case 3 A 50-year-old man presents to the emergency department with a history of a transient (less than 1 hour) slurring of speech and right-arm weakness. There is no history of prior cerebrovascular disease, and the physical examination reveals a focal, left-sided, systolic carotid bruit.
THE IMPORTANCE OF CLINICAL EXAMINATION The clinical significance of the identical-sounding bruit is vastly different in these patients. In each of them, the coupling of a thoughtful history with a competent
Footnotes
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Reprint requests to Division of General Internal Medicine, Henderson General Division, Room 408, McMaster Clinic, 711 Concession St, Hamilton, Ontario, Canada L8V 1C3 (Dr Sackett).
