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Physical examination

Important clues in the general physical

examination include the following.
  • Absent pulses (inferior extremity, radial, or carotid) favours a diagnosis of atherosclerosis with thrombosis;

    the sudden onset of a cold, blue limb favours embolism.

  • The internal carotid arteries in the neck cannot be reliably palpated but, in some patients, occlusion of

    the common carotid artery in the neck can be diagnosed by the absence of a carotid pulse.

  • The presence of a neck bruit suggests the presence of occlusive extracranial disease,especially if the bruit is long, focal, and high pitched.

  • Cardiac findings, especially atrial fibrillation, murmurs and cardiac enlargement, favour embolism from the heart.

  • Careful examination of the optic fundus may reveal cholesterol crystals, white platelet-fibrin, or red clot emboli. Subhyaloid hemorrhages in the eye suggest a suddenly developing brain or subarachnoid hemorrhage. When the carotid artery is occluded, the iris may appear speckled and the ipsilateral pupil can become dilated and poorly reactive. The retina in that circumstance may also show evidence of chronic ischemia (venous stasis retinopathy).

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