Hello,
Thank you for posting your query at DoctorSpring.com
I have noted your symptoms and agree that vertebro-basilar insufficiency (VBI) needs to be excluded in your case. Once it is ruled out aspirin can be started.
You should undergo two tests to confirm or exclude VBI- 1. MRI and MR angiogram brain, 2. Carotid and vertebral artery doppler.
You should also get screened for risk factors of VBI, such as high sugar, cholesterol and homocysteine.
If needed, aspirin tablets may be started. Once you have the reports, kindly get back to me, I will help you further.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Patient replied :
BRAIN MRI IMPRESSION: NO ACUTE INFARCT, HEMORRHAGE OR ENHANCING LESSION. FEW NONSPECIFIC SUPRATENTORIAL WHITE MATTER T2 HYPERINTENSITIES, OFTEN RELATED TO MICROVASCULAR CHANGES.
BRAIN MRA REPORT:
TECHNIQUE: IMAGES OF THE INTRACRANIAL ARTERIAL VASCULATURE WERE OBTAINED USING 3D TIME-OF-FLIGHT AND FLOW RELATED TECHIQUE. NO INTRAVENOUS CONTRAST WAS ADMINISTERED. MIP VIEWS ARE AVAILABLE FOR REVIEW.
FINDING:
BILATERAL DISTAL INTERNAL CAROTID ARTERIES, PETROUS INTERNAL CAROTID ARTERIES, CAVERNOUS CAROTID ARTERIES, SUPRACLINOID CAROTID ARTERIES ARE NORMAL IN CALIBER WITHOUT DISSECTION, ANEURYSM OR OCCLUSION.
THE ANTERIOR CEREBRALARTERIES COMPLEX ARE NORMAL IN CALIBER WITHOUT SIGNIFICANT STENOSIS, ANEURYSM OR OCCLUSION. THE MIDDLE CEREBRAL ARTERIES COMPLEX ARE NORMAL IN CALIBER WITHOUT ANEURYSMS, SIGNIFICANT STENOSIS OR OCCLUSION.
THE VERTEBRAL ARTERIES V3 AND V4 SEGMENTS AND BASILAR ARTERIES ARE NORMAL IN CALIBER. THE POSTERIOR CEREBRAL ARTERIES ARE NORMAL IN SIZE AND SYMMETRIC.NO DEFINITE ANEURYSM OR VASCULAR MALFORMATIONS IDENTIFIED THROUGH OUT THE INTRACRANIAL ARTERIAL VASCULARITY.
IMPRESSION: UNREMARKABLE BRAIN MRA WITHOUT CONTRAST.
Hello,
Thanks for getting back with the reports.
I have gone through your MRI and MRA report. The both reports are normal. But, it would help me to analyse better if you could upload your carotid and vertebral artery doppler reports. Please also do the investigations for sugar, cholesterol and homocysteine and kindly get back to me.
Feel free to discuss further
Patient replied :
hi DR.homocysteine 7.43 3.70 -13.90
cholesterol total 144.42 140.00 -220.00
cholesterol; HDL-LDL LDL 68.20 HDL. 53.61
SUGAR 93.83 60.00 -110.00
DOPPLER BOTH LIMBS: CHRONIC ATHEROSCLEROTIC DISEASE.
DOPPLER CAROTIDEO BOTH INTIMATE THICKENED.
THANK YOU VERY MUCH.
Thank you for getting back.
Blood tests are normal.
Limb doppler shows mild blockage of blood supply- please consult a vascular surgeon for that.
Carotid doppler shows mild blockage of blood supply.
As suggested, aspirin tablets may be taken after consulting your doctor.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Patient replied :
HI DR.WHAT MORE CAN I DO FOR FIND OUT WHAT IS GIVEN ME THOSE SINTOMS: TINITUS, VERTIGO, DOUBLE / BLURRY VISION, DIFFICULTY ON MY SPEECH, WALK LIKE DRUNK MAN, SWEATS COLD MY ARM AND MY NECK, TURN PALENESS WHEN I WALKS AROUND OUTSIDE, HEADACHES AND NECK PAIN, LEGS PAIN, I FELL LIKE I AM DRUNK.
AUDIOLOGY/VESTIBULAR EVAL, WAS NORMAL, MRI/MRA NORMAL, DOPPLER NORMAL, BLOOD LBS NORMAL.
THANK YOU VERY MUCH.
Thank you for getting back.
No more tests or investigations are needed from Neurology side, as all of them have already been done.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) |