Intracranial bruit may be due to a carotid cavernous sinus fistula or a cerebral angioma. It may also be due to a congenital arteriovenous anomaly. A cerebral aneurysm is rarely big enough to cause a bruit. Severe anemia may cause intracranial bruits without localized pathology being responsible. All intracranial bruits should be investigated with MRI and angiography unless some systemic disease is found (e.g., anemia) that would explain the sign.
Cervical bruits may be due to carotid stenosis, hyperthyroidism, a venous hum, or aortic stenosis with transmission of the bruit to the vessels in the neck. If hyperthyroidism and aortic stenosis can be excluded, a carotid duplex scan and possibly carotid angiography should be done to look for significant carotid stenosis. There is considerable controversy over whether asymptomatic carotid stenosis should be operated on. Nevertheless, a thorough workup should be done so the clinician knows what he is dealing with.
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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.
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Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9 
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