Clinical presentation

presentation

Carotid artery stenosis may be entirely asymptomatic.

Symptoms usually develop when the atherosclerosis plaque ruptures and causes an embolism more distally. These may include:

• ipsilateral amaurosis fugax, retinal infarction (which may affect an area of monocular vision (branch occlusion) or the entire retina (central occlusion))
• contralateral body TIA, or stroke
• visual field defect
• dysarthria
• in left sided carotid atherosclerosis, dysphasia due to involvement of the language centres located in the left cerebral hemisphere (1,2)

Some patients may present with non specific symptoms such as dizziness, generalized subjective weakness, syncope or near-syncope episodes, blurry vision, or transient positive visual phenomena (e.g. - floaters or stars). These patients are considered as asymptomatic patients even if high grade carotid stenosis is present (2).

Carotid bruits may be heard during carotid auscultation.

• have limited value for the diagnosis of carotid artery stenosis
• has a low sensitivity for the detection of moderate or severe carotid artery stenosis
  • bruits are usually absent in complete occlusion of the carotid artery since there is marked restriction of flow (1,2).

Reference:

• (1) Thapar A et al. Diagnosis and management of carotid atherosclerosis. BMJ. 2013;346:f1485.
• (2) Lanzino G, Rabinstein AA, Brown RD Jr. Treatment of carotid artery stenosis: medical therapy, surgery, or stenting? Mayo Clin Proc. 2009;84(4):362-87; quiz 367-8.