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Article
December 15, 1993

Does This Patient Have a Clinically Important Carotid Bruit?

Author Affiliations

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).

JAMA. 1993;270(23):2843-2845. doi:10.1001/jama.1993.03510230081040
Abstract

CLINICAL SCENARIOS 

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

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