Monday, July 12, 2010

Bruit I

This is the first part of a two part case.

This is an angiogram from a patient who presents with repeated episodes of 15 minutes of hand and arm numbness. This occurs on the left side and occasionally includes numbness of the cheek. These episodes have been going on for a while, about once or twice a week, all with similar symptoms and time course. They all resolve completely. Finally the patient's wife convinced him to come in and see you.

Challenge: What's the cause of the patient's symptoms (ie. what's the anatomic location of the lesion)?

Image is in the public domain.


Gabe said...

internal carotid artery plaque. do endarterectomy.

Suheil said...

Stenosis of the internal carotid artery just distal to the bifurcation of the carotids.. His symptoms suggest Transient Ischemic Attacks due to emboli from the site of the stenosis. If the stenosis is significant (>70%) an end-arterectomy may be performed.. for stenotic lesions less than that there isn't significant evidence to support active surgical intervention.

arif said...

Internal carotid artery stenosis with repeated embolisation

Craig Chen said...

sorry for the late reply...yes you are right!
Bruit I

The angiogram of the right carotid artery shows a stenotic lesion just past the carotid fork. These are TIAs due to carotid artery stenosis.

Sources: UpToDate;