Carotid Bruits

A carotid bruit is a blowing sound or murmur over the carotid artery, heard best with the bell of the stethoscope. It is usually associated with carotid stenosis secondary to atherosclerosis and may imply an increased risk of stroke, depending on the degree of stenosis and history of TIA or short-lived, stroke-like symptoms.

Differential Diagnosis

• Internal carotid artery stenosis
• External carotid artery stenosis
• Normal (nonstenotic), yet tortuous, carotid arteries
• Heart murmur with radiation to the neck (e.g., aortic stenosis)
• Excessive compression of the stethoscope over the neck vessels, resulting in deformity of vessel wall and turbulence
• Hyperthyroidism
  –Results in hyperdynamic circulation, tachycardia, and hypertension
• Takayasu's arteritis
  –Decreased pulses and bruits may occur over the abdominal aorta, carotid arteries, brachial arteries, and subclavian arteries
• Fisher's contralateral systolic bruit
  –Heard over the carotid bifurcation, eyeball, and/or skull on the “normal side” due to increased flow, as the “silent” side is completely occluded

Workup and Diagnosis

• Complete history and physical exam, with special attention to cardiac risk factors, TIA symptoms, cardiovascular exam, and neurologic exam
  –Bruit pitch increases as stenosis worsens, but may become silent when full occlusion occurs
  –Amaurosis fugax: Described as a “shade coming down over the eye” contralateral to the stenosis
• Laboratory evaluation includes lipid panel, CBC, glucose, electrolytes, homocysteine level (an independent risk factor for stroke), vitamin B₁₂ and folate levels, TSH, and ESR
• Carotid duplex ultrasound will evaluate the degree of stenosis
• MRA, CTA, or arteriography is indicated to better evaluate symptomatic stenosis that may require surgery

Treatment

• Patients with symptomatic stenosis (i.e., presence of TIA symptoms in the appropriate distribution) and >70% carotid stenosis confirmed on duplex ultrasound should strongly consider carotid endarterectomy
• Symptomatic patients with 50–69% stenosis have greater benefit from surgery than from medical approach
• Asymptomatic patients and those that cannot tolerate surgery should begin aspirin (60–325 mg/day) and/or antiplatelet therapy (e.g., ticlopidine, clopidogrel)
• Smoking and alcohol cessation
• Treat hypertension, diabetes, and hyperlipidemia
• Carotid angioplasty is currently under study
• Patients with underlying disease processes require appropriate treatment

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

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Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

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