Carotid detection

Eyeing stroke risk

Listen to the eyesÑnot the neckÑwhen screening for stroke risk or carotid disease, says Dr. David Thaler, assistant professor of neurology.

Among 280 patients he examined recently, 23 (8 percent) had discernable bruits, a whooshing noise that indicates partial blood vessel blockage, when the stethoscope was used over the eye, while only seven of those 23 had discernible bruits when the stethoscope was used on the neck. Twenty-one of the 23 had carotid disease.

"Many physicians routinely listen to their patients' necks for asymptomatic carotid disease. Few apply their stethoscopes to patients' eyes," says Thaler, who will present his research at an international conference of stroke experts in San Antonio, Texas, in early February. But he has found that "ocular bruits" are often the only warning sign of carotid trouble, a problem that often goes undiagnosed until there are serious health problems.

He adds that the best technique for listening to the eye includes having the patient hold his or her breath and keep the eye open. Use the bell side of the stethoscope to cup the eye and be sure to listen to both eyes. "Bruits are usually only in one eye," Thaler says. "If you hear it in the right eye, that typically means there is a problem in the patient's left side because there is an increased flow on the right side to compensate for the decreased left side flow."