Clinical indicators of extracranial carotid artery disease in patients with transient symptoms.

Clinical Indicators of Extracranial Carotid Artery Disease in Patients With Transient Symptoms • The clinical findings in 64 patients with transient symptoms of unilateral carotid system ischemic disease (amaurosis fugax or transient focal cerebral ischemic attacks or both) were reviewed in an effort to determine the value of the neurovascular examination in predicting the presence and extent of roentgenographically demonstrated ipsilateral extracranial internal carotid artery disease. Amaurosis fugax seems to be a highly specific indicator of disease, being associated with 4% of normal vessels as compared to 27% for patients with transient focal cerebral ischemic attacks alone. In patients with transient symptoms, the incidence of a normal, ipsilateral carotid artery was 36% in the absence of any positive neurovascular findings, 15% in the presence of an ipsilateral carotid bruit, 6% in the presence of ipsilateral retinal embolic events, 5% in the presence of ipsilateral reduction in superficial temporal or carotid (or both) pulse, 4% in the presence of an ipsilateral reduction in retinal artery pressure, and 3% when more than one of these findings were noted. The neurovascular examination appears to be a useful adjunct in detecting the presence or absence of ipsilateral carotid disease. However, no combination of symptoms or signs would, in all cases, allow one to accurately determine whether a vessel was abnormal, stenotic, or occluded. Additional Key Words neurovascular examination transient ischemic attacks amaurosis fugax retinal artery pressure carotid bruit retinal emboli • In recent years, increasing emphasis has been placed on the diagnosis and treatment of extracranial carotid atheromatous disease. Although angiography is the most definitive diagnostic procedure, it is not without significant risk, 1 and not all patients with suspected cerebrovascular disease should be subjected to this study. Therefore, as clinicians, we are frequently asked to determine the presence and nature of a potentially responsible lesion in the extracranial vessels on the basis of various historic and clinical findings. This study was conducted to review our observations in the clinical evaluation of extracranial carotid disease in patients with transient symptoms. Methods The clinical records of all patients who underwent cerebral angiography in the 25-month period between lanuary, 1970, and February, 1972, were studied (1,080 patients). From this group, we selected patients 537