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December 15, 1993, Vol 270, No. 23 >
ARTICLE | December 15, 1993

Does This Patient Have a Clinically Important Carotid Bruit? FREE

Jean-Stéphane Sauvé., MD; Andreas Laupacis, MD; Truls Østbye, MD; Brian Feagan, MD; David L. Sackett, MD
[+] Author Affiliations

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).


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

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

REFERENCES

1 +
Wadia NH, Monckton G.  Intracranial bruits in health and disease. Brain . 1957;;80:492-509.
2 +
Messert B, Marra TR, Zerofsky RA.  Supraclavicular and carotid bruits in hemodialysis patients. Ann Neurol . 1977;;2:535-536.
3 +
Matthews WB.  Observations on the carotid bruit. J Neurol Neurosurg Psychiatry . 1961;;24:161-166.
4 +
Ratcheson RA.  Clinical diagnosis of atherosclerotic carotid artery disease. Clin Neurosurg . 1982;; 29:464-481.
5 +
Harrison MJ.  Cervical bruits and asymptomatic carotid stenosis. Br J Hosp Med . 1984;;32:80-81.
6 +
Chambers BR, Norris JW.  Clinical significance of asymptomatic neck bruits. Neurology . 1985;;35: 742-745.
7 +
Jones FL.  Frequency, characteristics and importance of the cervical venous hum in adults. N Engl J Med . 1962;;267:658-660.
8 +
Hurst JW, Hopkins LC, Smith RB.  Noises in the neck. N Engl J Med . 1980;;302:862-863.
9 +
Fowler NO, Gause R.  The cervical venous hum. Am Heart J . 1964;;67:135-136.
10 +
Heyman A, Wilkinson WE, Heyden S, et al.  Risk of stroke in asymptomatic persons with cervical arterial bruits: a population study in Evans County, Georgia. N Engl J Med . 1980;;302:838-841.
11 +
Wolf PA, Kannel WB, Sorlie P, McNamara P.  Asymptomatic carotid bruit and risk of stroke: the Framingham Study. JAMA . 1981;;245:1442-1445.
12 +
Wiebers DO, Whisnant JP, Sandok BA, O'Fallon WN.  Prospective comparison of a cohort with asymptomatic carotid bruit and a population-based cohort without carotid bruit. Stroke . 1990;;21:984-988.
13 +
Hobson RW, Weiss DC, Fields WS, et al.  Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med . 1993;;328:221-227.
14 +
Van Ruiswyk J, Noble H, Sigmann P.  The natural history of carotid bruits in elderly persons. Ann Intern Med . 1990;;112:340-343.
15 +
Ivey TD, Strandness E, Williams DB, Langlois Y, Misbach GA, Kruse AP.  Management of patients with carotid bruit undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg . 1984;;87:183-189.
16 +
Evans WE, Cooperman M.  The significance of asymptomatic unilateral carotid bruits in preoperative patients. Surgery . 1978;;83:521-522.
17 +
Barnes RW, Liebman PR, Marszalek PB, Kirk CL, Goldman MH.  The natural history of asymptomatic carotid disease in patients undergoing cardiovascular surgery. Surgery . 1981;;90:1075-1081.
18 +
Ropper AH, Wechsler LR, Wilson LS.  Carotid bruit and risk of stroke in elective surgery. N Engl J Med . 1982;;307:1388-1390.
19 +
DerSimonian R, Laird N.  Meta-analysis in clinical trials. Controlled Clin Trials . 1986;;7:177-188.
20 +
Yusuf S, Peto R, Lewis J, Collins R, Sleight P.  Beta blockade during and after myocardial infarction: and overview of the randomized trials. Prog Cardiovasc Dis . 1985;;27:335-371.
21 +
North American Symptomatic Carotid Endarterectomy Trial Collaborators (NASCET).  Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med . 1991;;325:445-453.
22 +
European Carotid Surgery Trialists' Collaborative Group.  NRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or mild (0-29%) carotid stenosis. Lancet . 1991;;337:1235-1243.
23 +
Ingall TJ, Homer D, Whisnant JP, Baker HL, O'Fallon WN.  Predictive value of carotid bruit for carotid atherosclerosis. Arch Neurol . 1989;;46:418-422.
24 +
Ziegler DR, Zileli T, Dick A, Sebaugh JL.  Correlation of bruits over the carotid artery with angiographically demonstrated lesions. Neurology . 1971;;21:860-865.
25 +
Hankey GJ, Warlow CP.  Symptomatic carotid ischaemic events: safest and most cost effective way of selecting patients for angiography, before carotid endarterectomy. BMJ . 1990;;300:1485-1491.
26 +
Sauvé S, Sackett DL, Taylor DW, Barnett HJM, Haynes RB, Fox A, on behalf of the NASCET.  Can bruits distinguish high-grade from moderate symptomatic carotid stenosis? Clin Res . 1992;;40:304A.
27 +
Haynes RB, Taylor DW, Sackett DL, Fox A, Rankin R, Barnett H.  Poor performance of doppler in detecting high-grade carotid stenosis. Clin Res . 1992;;40:184A.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Wadia NH, Monckton G.  Intracranial bruits in health and disease. Brain . 1957;;80:492-509.
2 +
Messert B, Marra TR, Zerofsky RA.  Supraclavicular and carotid bruits in hemodialysis patients. Ann Neurol . 1977;;2:535-536.
3 +
Matthews WB.  Observations on the carotid bruit. J Neurol Neurosurg Psychiatry . 1961;;24:161-166.
4 +
Ratcheson RA.  Clinical diagnosis of atherosclerotic carotid artery disease. Clin Neurosurg . 1982;; 29:464-481.
5 +
Harrison MJ.  Cervical bruits and asymptomatic carotid stenosis. Br J Hosp Med . 1984;;32:80-81.
6 +
Chambers BR, Norris JW.  Clinical significance of asymptomatic neck bruits. Neurology . 1985;;35: 742-745.
7 +
Jones FL.  Frequency, characteristics and importance of the cervical venous hum in adults. N Engl J Med . 1962;;267:658-660.
8 +
Hurst JW, Hopkins LC, Smith RB.  Noises in the neck. N Engl J Med . 1980;;302:862-863.
9 +
Fowler NO, Gause R.  The cervical venous hum. Am Heart J . 1964;;67:135-136.
10 +
Heyman A, Wilkinson WE, Heyden S, et al.  Risk of stroke in asymptomatic persons with cervical arterial bruits: a population study in Evans County, Georgia. N Engl J Med . 1980;;302:838-841.
11 +
Wolf PA, Kannel WB, Sorlie P, McNamara P.  Asymptomatic carotid bruit and risk of stroke: the Framingham Study. JAMA . 1981;;245:1442-1445.
12 +
Wiebers DO, Whisnant JP, Sandok BA, O'Fallon WN.  Prospective comparison of a cohort with asymptomatic carotid bruit and a population-based cohort without carotid bruit. Stroke . 1990;;21:984-988.
13 +
Hobson RW, Weiss DC, Fields WS, et al.  Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med . 1993;;328:221-227.
14 +
Van Ruiswyk J, Noble H, Sigmann P.  The natural history of carotid bruits in elderly persons. Ann Intern Med . 1990;;112:340-343.
15 +
Ivey TD, Strandness E, Williams DB, Langlois Y, Misbach GA, Kruse AP.  Management of patients with carotid bruit undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg . 1984;;87:183-189.
16 +
Evans WE, Cooperman M.  The significance of asymptomatic unilateral carotid bruits in preoperative patients. Surgery . 1978;;83:521-522.
17 +
Barnes RW, Liebman PR, Marszalek PB, Kirk CL, Goldman MH.  The natural history of asymptomatic carotid disease in patients undergoing cardiovascular surgery. Surgery . 1981;;90:1075-1081.
18 +
Ropper AH, Wechsler LR, Wilson LS.  Carotid bruit and risk of stroke in elective surgery. N Engl J Med . 1982;;307:1388-1390.
19 +
DerSimonian R, Laird N.  Meta-analysis in clinical trials. Controlled Clin Trials . 1986;;7:177-188.
20 +
Yusuf S, Peto R, Lewis J, Collins R, Sleight P.  Beta blockade during and after myocardial infarction: and overview of the randomized trials. Prog Cardiovasc Dis . 1985;;27:335-371.
21 +
North American Symptomatic Carotid Endarterectomy Trial Collaborators (NASCET).  Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med . 1991;;325:445-453.
22 +
European Carotid Surgery Trialists' Collaborative Group.  NRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or mild (0-29%) carotid stenosis. Lancet . 1991;;337:1235-1243.
23 +
Ingall TJ, Homer D, Whisnant JP, Baker HL, O'Fallon WN.  Predictive value of carotid bruit for carotid atherosclerosis. Arch Neurol . 1989;;46:418-422.
24 +
Ziegler DR, Zileli T, Dick A, Sebaugh JL.  Correlation of bruits over the carotid artery with angiographically demonstrated lesions. Neurology . 1971;;21:860-865.
25 +
Hankey GJ, Warlow CP.  Symptomatic carotid ischaemic events: safest and most cost effective way of selecting patients for angiography, before carotid endarterectomy. BMJ . 1990;;300:1485-1491.
26 +
Sauvé S, Sackett DL, Taylor DW, Barnett HJM, Haynes RB, Fox A, on behalf of the NASCET.  Can bruits distinguish high-grade from moderate symptomatic carotid stenosis? Clin Res . 1992;;40:304A.
27 +
Haynes RB, Taylor DW, Sackett DL, Fox A, Rankin R, Barnett H.  Poor performance of doppler in detecting high-grade carotid stenosis. Clin Res . 1992;;40:184A.

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