Height loss caused by bent posture: A risk factor for stroke from ENT clinic - is it time to reconsider the physical examination?

CONCLUSION When excessive height loss occurs in the elderly, which may be indicated by a cervical-bent posture, examination of the head and neck should be performed to detect common carotid artery (CCA) and internal carotid artery (ICA) aberration. In such cases brain magnetic resonance imaging (MRI) examination should be conducted to determine whether infarction is present. OBJECTIVES To examine the relationships among bent posture, height loss, aberration of carotid arteries, and ischemic stroke risk with a case-control study. METHODS Controls (n = 163) were selected from among patients who had undergone MRI of the brain because of otolaryngologic symptoms. Case patients (n = 72) were selected from among those whose primary diagnosis was cerebral infarction in the area served by the ICA. Both groups were age-matched between 65 and 84 years old. The neck and pharyngeal cavity in each of the 235 patients were examined to determine whether the carotid arteries exhibited aberration. Patients' current height and greatest lifetime height were recorded, along with presence or absence of bent posture and other stroke risk factors. RESULTS Height loss alone could predict stroke risk in 79.1% of patients: 90.2% based on carotid artery aberration and 91.4% when all risk factors (aberration of carotid artery, height loss, bent posture) were analyzed.