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Clinical features

Authoring team

Typically, progressive obliteration of the lumen of the internal carotid artery by atheroma and thrombus produces the picture of a 'stuttering' stroke characterised by:

  • progressing contralateral hemiparesis and hemisensory disturbance
  • transient ipsilateral visual impairment due to retinal ischaemia
  • unilateral frontal headache

In more extreme cases, there is additionally:

  • deterioration of consciousness
  • homonymous hemianopia of the contralateral side
  • partial Horner's syndrome on the ipsilateral side
  • global aphasia if the dominant hemisphere is affected

On examination:

  • bruit at the angle of the jaw
  • facial and scalp pulses more prominent on the affected side; become impalpable if total occlusion develops

Reference

  1. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. April 2022 [internet publication].

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