Table 1.1

Evaluation for Cerebrovascular Disease—Potential Signs and/or Symptoms

IndicationAppropriate Use Score (1–9)
1.
  • New or worsening hemispheric neurological symptoms (e.g., unilateral motor or sensory deficit, speech impairment, or amaurosis fugax)

  • Evaluation of transient ischemic attack or stroke

A (9)
2.
  • Hollenhorst plaque visualized on retinal examination

A (8)
3.
  • Lightheadedness or impaired vision in the setting of upper extremity exertion

  • Evaluation for subclavian–vertebral steal phenomenon

A (7)
4.
  • Syncope of uncertain cause after initial cardiovascular evaluation

U (5)
5.
  • Suspected symptomatic vertebrobasilar occlusive disease in the symptomatic patient (e.g., vertigo, ataxia, diplopia, dysphagia, dysarthria)

A (7)
6.
  • Evaluation for suspected carotid artery dissection

A (8)
7.
  • Pulsatile neck mass

A (8)
8.
  • Cervical bruit

  • No prior carotid artery assessment

A (7)

A = appropriate; I = inappropriate; U = uncertain.