<s>[INST] Diagnosis of Cerebrovascular Disease [/INST] At BWH, our vascular disease specialists provide expert evaluation and diagnosis with the aid of the latest in advanced imaging technologies.

The presence of a carotid artery narrowing may be suggested by one of the warning signs described above. Many patients, however, will be completely asymptomatic, despite significant narrowing of a carotid artery. In many such patients, a careful physical examination will reveal the presence of an audible bruit (abnormal sound heard through a stethoscope) in the neck, caused by disturbed blood flow through the carotid artery.

When a medical history or physical examination suggests potential carotid artery narrowing, the patient is generally sent for a noninvasive imaging study to evaluate the carotid arteries. These studies may include a duplex ultrasound study or a magnetic resonance angiogram. Both are completely noninvasive and highly accurate tests to determine the presence and extent of carotid artery narrowing. When a carotid artery narrowing of greater than 80 percent is found, consideration for repair of the artery is appropriate.

Patients who have had warning signs for stroke and are found to have significantly narrowed carotid arteries are recommended for artery repair. Asymptomatic patients with severe carotid artery narrowing are selectively recommended for intervention based on their age and overall health status.

Most cerebral aneurysms go undiagnosed until after they have ruptured. In these cases, specialists from our Department of Neurosurgery’s Center for Stroke and Cerebrovascular Diseases will use diagnostic methods to confirm a diagnosis of aneurysm and to help guide treatment. These methods may include one or more of the following tests:

Cardiac CT angiography
Cardiac Computed Tomography (CT)
Cardiac Magnetic Resonance Imaging (MRI)
Spine fluid analysis Source: BRIGHAM AND WOMENS. Link: https://www.brighamandwomens.org/heart-and-vascular-center/diseases-and-conditions/heart-valve-disease. Field: Cardiovascular. Disease: Cerebrovascular Disease </s>