In a patient presenting with acute stroke Ischemic Stroke Ischemic stroke is sudden neurologic deficits that result from focal cerebral ischemia associated with permanent brain infarction (eg, positive results on diffusion-weighted MRI). Common causes... read more , 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 Overview of Arrhythmias The normal heart beats in a regular, coordinated way because electrical impulses generated and spread by myocytes with unique electrical properties trigger a sequence of organized myocardial... read more . Bruits over the cranium may indicate an arteriovenous malformation Cerebral Arteriovenous Malformations (AVMs) Arteriovenous malformation (AVMs) are tangled, dilated blood vessels in which arteries flow directly into veins. AVMs occur most often at the junction of cerebral arteries, usually within the... read more 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 Peripheral Arterial Disease Peripheral arterial disease (PAD) is atherosclerosis of the extremities (virtually always lower) causing ischemia. Mild PAD may be asymptomatic or cause intermittent claudication; severe PAD... read more . The temporal arteries are palpated; enlargement or tenderness may suggest temporal arteritis Giant Cell Arteritis Giant cell arteritis involves predominantly the thoracic aorta, large arteries emerging from the aorta in the neck, and extracranial branches of the carotid arteries. Symptoms of polymyalgia... read more .