Cerebrovascular examination

[Oralee]

In a patient presenting with acute stroke, radial pulse and BP in the 2 arms are compared to check for painless aortic dissection, which can occlude a carotid artery and cause stroke. The skin, sclerae, fundi, oral mucosae, and nail beds are inspected for hemorrhages and evidence of cholesterol or septic emboli.
Auscultation over the heart can detect new or evolving murmurs and arrhythmias. Bruits over the cranium may indicate an arteriovenous malformation or fistula or, occasionally, redirected blood flow across the circle of Willis after carotid occlusion. Auscultation over the carotid arteries can detect bruits near the bifurcation; vigorous palpation should be avoided. By running the bell of the stethoscope down the neck toward the heart, the examiner may identify a change in character that can distinguish a bruit from a systolic heart murmur. Decreased vigor of the carotid upstroke or a bruit that continues into diastole suggests severe stenosis.
Peripheral pulses are palpated to check for peripheral vascular disease. The temporal arteries are palpated; enlargement or tenderness may suggest temporal arteritis.