Carotid Artery Disease
MRCS Part A & B — Comprehensive Study Notes
Carotid Artery Disease: Clinical Presentations
Spectrum of Neurological Presentations
Transient Ischaemic Attack (TIA): Sudden focal neurological deficit lasting <24 hours, fully resolving. The episode is from carotid stenosis causing emboli or haemodynamic compromise. The most fear-inducing presentation because high-risk stroke period follows. Amaurosis fugax: Transient monocular blindness (vision loss in one eye only), described as “curtain coming down” from above, lasting minutes to an hour, then completely resolving. This is from ischaemia of the ophthalmic artery (branch of the internal carotid), indicating proximal ICA stenosis with emboli travelling to the ophthalmic territory. RIND (Reversible Ischaemic Neurological Deficit): Neurological deficit resolving within 24 hours, but after 3 hours (distinguishing it from TIA). Now considered minor stroke rather than separate entity. Stroke: Permanent neurological deficit (present >24 hours, often permanent). Crescendo TIA: Multiple TIAs occurring within 24 hours—very high-risk pattern (8% 2-day stroke risk) requiring urgent intervention.
ABCD2 Score for TIA Risk Stratification
Helps identify which TIA patients are at highest risk for subsequent stroke and need most urgent intervention:
| Factor | Points |
|---|---|
| Age ≥60 years | 1 |
| Blood pressure ≥140/90 mmHg | 1 |
| Clinical features: unilateral weakness | 2 |
| Clinical features: speech disturbance (without weakness) | 1 |
| Duration of TIA: ≥60 minutes | 2 |
| Duration of TIA: 10–59 minutes | 1 |
| Diabetes | 1 |
Score 6–7 = high risk (8% 2-day stroke risk); 4–5 = moderate; 0–3 = low. High-risk patients need urgent imaging and intervention.