Direct Thermometry, Ophthalmodynamometry, Auscultation and Palpation in Extracranial Cerebrovascular Disease: An Evaluation of Rapid Diagnostic Methods

Abstract

• The ability of four rapid diagnostic tests-direct thermometry, ophthalmodynamometry, and bruit and pulse assessment-to discriminate for the presence or absence of significant extracranial cerebrovascular disease is examined. Utilized separately thermometry, ophthalmodynamometry and the examination for a bruit will find over 75% to 85% of cases. Pulse assessment alone reveals only 40% of significant lesions. The combination of neck examination for the presence of a bruit or pulse deficit alone will discover 93% of the vascular lesions. In the present series 100% of cases were found by including either direct thermometry or ophthalmodynamometry in combination with the aforementioned two tests.Ophthalmodynamometry accurately located the side of the major lesion in more than 90% of the cases. The direct thermometry technique scored below 40% in lesion localization. It is suggested that the thermometry technique, because of the ease of its performance, should be utilized in combination with the neck examination as the preliminary step in assessing patients with suspected extracranial cerebrovascular disease. Ophthalmodynamometry should then be used for more accurate localization of the lesion prior to angiography.

Quantitative carotid phonoangiography.

“…u Shapiro and co-workers 11 found a correlation between the presence of a bruit and disease in 71.5% of their patients. However, all of their patients had a 50% or more stenosis of the underlying vessel.…”

“…However, all of their patients had a 50% or more stenosis of the underlying vessel. David and coworkers 11 noted that in a group of patients with transient ischemic attacks, 75% of the carotid bruits were associated with stenotic lesions. In asymptomatic pa- tients, 65% of the vessels with bruits were associated with disease.…”

Disease at the Carotid Bifurcation: Diagnosis by Doppler Ultrasound Imaging

“…Nonirivasive techniques for investigating cerebro vascular disease have been developed to avoid the complications which occur using X-rays. However, most of these techniques are unable to demonstrate whether the disease is in the IC artery near the carotid bifurcation where it is accessible to surgery (Kartchner et al, 1973;Shapiro et al, 1970).…”