From the Guidelines
A carotid artery scan should be considered for a 66-year-old female experiencing dizziness if it is accompanied by other neurological symptoms, as recommended by the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack 1.
Key Considerations
- The patient's symptoms should be thoroughly evaluated to determine if cerebral ischemia is a plausible cause, as suggested by the 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease 1.
- A carotid ultrasound might be considered for patients with nonspecific neurological symptoms when cerebral ischemia is a plausible cause, according to the 2011 guideline 1.
- The 2021 guideline recommends noninvasive cervical carotid imaging with carotid ultrasonography, CT angiography (CTA), or magnetic resonance angiography (MRA) to screen for stenosis in patients with symptomatic anterior circulation cerebral infarction or TIA who are candidates for revascularization 1.
Evaluation and Testing
- A thorough evaluation by a healthcare provider is essential before proceeding with specific tests, including a physical examination, blood pressure measurements, neurological assessment, and evaluation of the ears.
- The provider should consider the patient's age, medical history, and risk factors for atherosclerosis when determining the need for a carotid artery scan.
- Other causes of dizziness, such as inner ear problems, blood pressure issues, or medication side effects, should be ruled out before proceeding with a carotid artery scan.
Recommendations
- A carotid artery scan should be considered for a 66-year-old female experiencing dizziness if it is accompanied by other neurological symptoms, as recommended by the 2021 guideline 1.
- The patient's symptoms and medical history should be thoroughly evaluated to determine the need for a carotid artery scan.
- A carotid ultrasound or other noninvasive imaging modalities may be considered to screen for stenosis in patients with symptomatic anterior circulation cerebral infarction or TIA who are candidates for revascularization 1.
From the Research
Dizziness in a 66-year-old Female
- The patient's symptom of dizziness is a common yet imprecise symptom, and its evaluation focuses on determining whether the etiology is peripheral or central 2.
- Peripheral etiologies are usually benign, while central etiologies often require urgent treatment 2.
- The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies 2.
Consideration of Carotid Artery Scan
- There is no direct evidence to suggest that a carotid artery scan is necessary for a 66-year-old female with dizziness, unless there are other symptoms or risk factors that suggest carotid stenosis 2, 3, 4.
- Carotid artery imaging is important for the evaluation of patients with ischemic stroke or TIA, and CT angiography is a useful screening test for internal carotid artery stenosis 3, 4.
- However, in the context of geriatric dizziness, the approach to diagnosis and treatment is challenging, and the risk of vascular events is higher in the first 30 days than after, suggesting some missed diagnoses 5.
Diagnostic Approaches
- The cost-effectiveness of CT angiography in the work-up of patients with recent TIA or minor ischemic stroke who are suspected of having carotid artery stenosis has been evaluated, and the results suggest that duplex US combined with CT angiography and surgery for 70%-99% stenoses is the most cost-effective strategy 6.
- However, the patient's symptoms and medical history should be carefully evaluated to determine the most appropriate diagnostic approach 2, 5.