Intracranial bruits can be heard best over the orbits or mastoids. A list of possible causes can be developed by using the mnemonic MINTS.
· M—Malformations should bring to mind arteriovenous malformations of the brain and persistent trigeminal artery.
· I—Inflammatory lesions do not customarily cause intracranial bruits.
· N—Neoplasm would bring to mind a cerebral angioma.
· T—Trauma would suggest a traumatic caroticocavernous fistula.
· S—Systemic disease such as anemia, thyrotoxicosis, and Paget disease may cause an intracranial bruit.
A cervical bruit (page 83) may be transmitted to the orbit.
Approach to the Diagnosis
If a systemic disease has been excluded by routine laboratory studies and a thyroid panel, serious investigation with an MRI or cerebral angiography should be considered. It is wise to consult a neurologist for guidance.