Table 1.1.

Evaluation for Cerebrovascular Disease—Potential Signs and/or Symptoms

Indication		Appropriate Use Score (1–9)
1.	• New or worsening hemispheric neurological symptoms (eg, 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 (eg, 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.