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).
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.
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
Sauvé. J, Laupacis A, Østbye T, Feagan B, Sackett DL. Does This Patient Have a Clinically Important Carotid Bruit?. JAMA. 1993;270(23):2843-2845. doi:10.1001/jama.1993.03510230081040