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Pathophysiology

1. Aetiology
   • Atherosclerosis
   • Dissection
   • Trauma
   • Previous carotid surgery 

Approach

• Expose neck
• Proceed as for neck examination

1. Inspect
   • Pulsatile swelling noted in line of carotid artery at base of neck
   • Normally unilateral
2. Palpate
   • Firm
   • Expansile
3. Percuss
4. Auscultate
   • Usually a bruit is heard

Completion

1. Look for neurological associations (ipsilateral horner's syndrome; focal neurological signs)
2. Examine for cardiovascular associations (BP, peripheral pulses, heart)

Investigations

• Duplex scan
• Digital subtraction angiography