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Headache associated with nonvascuiar intracranial disorders
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Another feature of idiopathic intracranial hypertension is a cranial bruit that may be audible to observers. The bruit, caused by turbulence in the major venous sinuses, may be soft- or high-pitched and is best auscultated with the bell over the mastoid or the temporalis while the mouth is held open.142
Pharynx, Larynx and Neck
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
There is often a long history of a slowly enlarging, painless lump at the carotid bifurcation. About one-third of patients present with a pharyngeal mass that pushes the tonsil medially and anteriorly. The mass is firm, rubbery, pulsatile, mobile from side to side but not up and down, and can sometimes be emptied by firm pressure, after which it slowly refills in a pulsatile manner. A bruit may also be present. Swellings in the parapharyngeal space, which often displace the tonsil medially, should not be biopsied from within the mouth.
Neck and endocrine
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
There is a lump up to 4–5cm in size that moves from side to side, but not up and down. It exhibits a transmitted but not an expansile pulse. Bruit may be present and may reduce in size with carotid compression. Large tumours may involve IX, X, XI and XII nerves and occasionally the sympathetic chain, causing Horner’s syndrome.
Paclitaxel coated balloon versus conventional balloon angioplasty in dysfunctional dialysis arteriovenous fistula: a systematic review and meta-analysis of randomized controlled trials
Published in Renal Failure, 2022
Chuxuan Luo, Mingzhu Liang, Yueming Liu, Danna Zheng, Qiang He, Juan Jin
The endpoint events were defined in accordance with the Society of Interventional Radiology (SIR) criteria for percutaneous interventional procedures in dialysis access [23] and the previous literature [12,15,19]. TLPP was adjudicated as freedom from clinically-driven target lesion revascularization (CD-TLR) or access circuit thrombosis during the follow-up period. TLPP ended when any one of the followings occurred: (1) decreased access blood flow (<500mL/min, 25% decrease in flow); (2) elevated venous pressures; (3) decreased dialysis dose (Kt/V); (4) abnormal physical exam included: i. diminished or abnormal thrill (focal, systolic only, etc); ii. pulsatility; iii. flaccid access; iv. abnormal bruit; v. arm or hand swelling; (5) prolonged bleeding; (6) difficult puncture; (7) infiltration; (8) recirculation; (9) pulling clots. Technical success was defined as successful completion of the angioplasty procedure with <30% residual stenosis by visual estimate and a palpable thrill. All-cause mortality was reported through 12 months. Data were separately extracted by two review authors (LC and LM).
Treatment of low flow, indirect cavernous sinus dural arteriovenous fistulas with external manual carotid compression – the UK experience
Published in British Journal of Neurosurgery, 2020
Pratipal Kalsi, Rajeev Padmanabhan, Manjunath Prasad K. S., Nitin Mukerji
CS-DAVF usually occur in middle aged and elderly females but they can occur in any age group or sex. Clinical symptoms depend on whether the fistula drains anteriorly or posteriorly. Anteriorly draining CS-DAVF often present with visual symptoms, which include conjunctival injection, chemosis, extraocular nerve palsies leading to ohthalmoplegia, proptosis, retro-orbital pain and obtundation if an intracerebral hemorrhage occurs. Some patients may also have a bruit.4,5 Raised episcleral venous pressure may lead to an increase in intracocular pressure and visual loss. Visual loss is less common than in direct CS-DAVF but can occur in up to 30% of patients.6,7 CS-DAVF draining into the superior and inferior petrosal sinuses are usually asymptomatic. These patients don’t usually have ocular symptoms but can present with cranial nerve palsies.8–10 Infrequently posteriorly draining fistulas can cause brainstem congestion and neurological deficits.11 20-50% CS-DAVFs of will close spontaneously.12,13 Intracranial haemorrhage is an extremely rare complication.14
Rationale for screening selected patients for asymptomatic carotid artery stenosis
Published in Current Medical Research and Opinion, 2020
Kosmas I. Paraskevas, Hans-Henning Eckstein, Dimitri P. Mikhailidis, Frank J. Veith, J. David Spence
According to the 2011 SVS guidelines25, although routine screening in the general population is not recommended, screening for ACS should be considered in certain groups of patients with multiple risk factors that increase the incidence of disease as long as the patients are fit for and willing to consider carotid intervention if significant stenosis is discovered. Such groups of patients include those with evidence of clinically significant peripheral artery disease regardless of age and patients ≥65 years with a history of CHD, smoking and/or hypercholesterolemia25. Patients with carotid bruits (an indicator of not only ACS, but also systemic atherosclerosis, as well as a prognostic indicator of cardiovascular death and MI)26,27 should also be considered for carotid screening. This was a recommendation in the 2009 ESVS guidelines28,29. The 2018 ESVS Guidelines gave a recommendation for selective screening for ACS in patients with multiple vascular risk factors but this was a weak (Class: IIb, Level of Evidence: C) and non-specific recommendation. The 2018 ESVS guidelines also recommended screening for ACS prior to coronary artery bypass grafting (CABG) in patients with a carotid bruit2. Detection of a carotid bruit and/or ACS should be viewed as an opportunity for initiation of intensive BMT, not for offering a carotid intervention, as ACS is not associated with an increased risk of stroke and mortality in patients undergoing CABG30,31.