Clinical features

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].