Q: Finding of neck bruit on physical examination in a stroke patient is a clue to which type of stroke before any radiological finding is available?
A) Intracerebral hemorrhage (ICH) B) Subarachnoid hemorrhage (SAH) C) Ischemic (thrombotic) D) Ischemic (embolic) E) It is an irrelevant finding
History and physical exam can give good clues about types of strokes.
ICH usually occurs gradually, more common in the Afro-American and Asian population, and usually, precipitate by physical activity. It carries its own risk factors like hypertension, trauma or vascular malformations.
In contrast, SDH is well known to have a hallmark of an abrupt onset of a severe headache, classically defined as the "worst headache of life".
Ischemic (thrombotic) stroke is usually marked by stuttering progression with periods of improvement. Neck bruit is frequently present on exam.
Ischemic (embolic) stroke has a classic description of sudden onset with deficit maximal at onset. Classic history is precipitation by getting up at night to urinate.
References: 1. Wang MY, Mimran R, Mohit A, et al. Carotid stenosis in a multiethnic population. J Stroke Cerebrovasc Dis 2000; 9:64.
2. Wolma J, Nederkoorn PJ, Goossens A, et al. Ethnicity a risk factor? The relation between ethnicity and large- and small-vessel disease in White people, Black people, and Asians within a hospital-based population. Eur J Neurol 2009; 16:522.
3. Rockman CB, Hoang H, Guo Y, et al. The prevalence of carotid artery stenosis varies significantly by race. J Vasc Surg 2013; 57:327.