This is to determine the cause of the dizziness from the rotation?
So, the two problems could actually coexist—the venous issue and the mechanical one. That would also explain symptoms such as pain triggered by rotation or pain affecting one side of the head. Maybe that’s the most accurate hypothesis.
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I’ll send an email to the Arráez team, mentioning the negative result of the test and that it could potentially be an error. I’ll also suggest some kind of dynamic imaging, such as a rotational CT scan, to assess how C1 moves and which structures might be getting irritated with movement and potentially causing the symptoms.
I’m attaching the MRI. I’ll ask them to repeat it because there are some things that cannot be seen clearly.
I’ll send an email to the Arráez team, mentioning the negative result of the test and that it could potentially be an error. I’ll also suggest some kind of dynamic imaging, such as a rotational CT scan, to assess how C1 moves and which structures might be getting irritated with movement and potentially causing the symptoms.
I’m attaching the MRI. I’ll ask them to repeat it because there are some things that cannot be seen clearly. @Filya @med3
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I don’t see any signs of CSF leak in the MRI
Maybe you can propose Arraez’s team guided lidocaine injections. If you feel better after them, there is a good chance that is muscular/ligament or even nerve related.
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@med3 - We’ve had a number of members who’ve had ultrasound guided lidocaine/cortisone injections for diagnostic purposes as you suggest. For some, their symptoms did reduce, for others they got worse & for still others they did nothing. We don’t feel the lidocaine injections are a consistently reliable diagnostic tool.
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Sure, then what do you propose for normal mri, normal ct scan and negative manometry?
A second & possibly third opinion about what the imaging shows would be my proposal. There are several doctors on our doctors list, both in the US & internationally, who are very experienced doing styloidectomies w/ IJV decompressions & who are all willing to provide opinions about imaging via consults. Yes, there is a fee for getting each one’s opinion, but that is one way to see how other doctors perceive what imaging shows. It ultimately lies on the patient to decide which opinion makes the most sense based on his/her symptoms & knowledge about the things that can cause them.
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@nemo there is this doctor in Spain specialist in eagle, ask for a consultation. Probably you can send him all the tests.
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The fact that there are no signs of a CSF leak on the MRI doesn’t mean everything is normal. The CT scan is not normal, and I suspect the manometry may not have been performed optimally for several reasons (although even if it were truly negative, I still wouldn’t consider that enough to completely rule out the hypothesis).
Injections in that area might be an option, but first we need to rule out, as thoroughly as possible, mechanical causes of irritation, such as abnormal movement of C1 or other nearby structures.
Thanks for reviewing the MRI
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That’s what I’m going to do. I’ll get opinions from surgeons on the list and/or from surgeons with a strong reputation in skull base surgery in general, to determine whether the cause is mechanical, venous, or both, and then decide how to proceed
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I know him. He’s an ENT specialist, so I don’t think he operates on the skull base/C1 himself, although perhaps he works as part of a multidisciplinary team idk. I’ve heard mixed opinions about him, so I think I’ll first see a neurosurgery team in Barcelona or Madrid
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@nemo You don’t have a vascular compression problem. Do you have pulsatile tinnitus (a whooshing sound in the ear)? Do you have signs of intracranial hypertension, like papilledema?
You can ask for another manometry, but it’s not going to show anything different. The CT is normal in the sense that the apparent C1 compression is just an incidental finding (see the manometry). The fact that the MRI is normal doesn’t mean you don’t have a problem; it just means that current MRI technology doesn’t show anything problematic in the images.
Whether the problem is not vascular but rather a compression issue, like a nerve compression or irritation, remains to be seen.
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Exactly. I have symptoms that could perhaps be caused by nerve irritation but that may also resemble vascular compression.
However, I have had and still have other clear symptoms, such as a drastic worsening with the Valsalva maneuver, a feeling of fullness in the ear, hearing my heartbeat in the ear, and the dilated jugular bulb. And I also have other symptoms that clearly seem more consistent with nerve irritation.
It’s probably a combination of both. Since they appeared at the same time, I imagine they may be resolved in the same way
The issue with the manometry is that there may have been an error in how the test was performed, particularly because of the positions used during the measurements and the sedation. That still needs to be clarified
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Some members have asked for an opinion on their imaging from Kjetil Larsen at MSK Neurolgy, he has helped lots of members & has spotted things which radiologists have missed, might be worth getting an online consultation as well as / instead of some of the ES doctors?
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@nemo Ask for dynamic ct/mri flexion extension head rotation for possible cervical inestability.
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- I’m pretty sure they didn’t take your blood pressure. Since pressure sensors are very expensive, the equipment is very expensive, and most do not believe in veins. Why would they need equipment and spend money on pressure measurement? In Russia, major scientific institutes do not have pressure measuring equipment . They gave you a regular DSA venography with head swipes/rotations, and there were no pressure measurements. They didn’t measure blood pressure, they just looked at the contrast passing through the veins on the DSA venography. And based on this, they concluded that you have no problems with venous drainage)))))) Of course, this opinion has a right to life, but …
The pressure measurement protocol is just a fiction or an error (which I doubt, since I doubt they actually measured blood pressure).
Scientific medical centers can use a Pitot tube (Henri Pitot) to measure pressure — this is an accurate and inexpensive method, but you need to know how to do it. A U‑shaped tube with a scale (tubes similar to those used in a medical IV drip). For example, 20 mm Hg is 27 cm of water column (adjusted for blood density and viscosity). That is, it is possible to measure this with relatively low costs, but it requires knowledge of hydrodynamics, which, unfortunately, doctors do not have.
2)Read about Doppler scanning in my topics at the very beginning (I won’t repeat it)
3)first of all, you need to do a Doppler scan, measuring the volumetric velocity (ml/min), but only correct measurements with angle correction (this is the whole problem, because you cannot rely on 100% of the Doppler scan data due to errors). With a high probability, the measured values of volumetric blood flow (or even blood flow velocity) will be incorrect.
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DSA angiography (your left vertebral artery looks problematic). it may or may not produce symptoms. Perhaps the problems with the veins are increasing. It is difficult.
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Will you do a CT scan with a head rotation and then what decision? You’ll see dynamic compression (decompression), and what’s next? You’ve had a DSA venography with head turns, and there may already be information on them (on the DSA venography scans ).
Theoretically, sedation can relax the neck muscles, thereby creating space between the muscles, and your vertebral veins will dilate, as will the SCM muscle and the left IJV. This is also not ruled out, but there is no confirmation.
google drive
Example. We return to the issue that doctors do not know the laws of hydrodynamics, and their measurements of the gradient (pressure difference) are highly questionable. And it happens that doctors make mistakes in medical articles. An example is the medical article “Pearls & Oy-sters” neurovascular core clinical lesson published by Primiani, Lawton, et al. (2022). This article states that after surgery, the gradient is zero (the difference in pressure at two points, with the sigmoid venous sinus between them). And this is incorrect. Because the sigmoid venous sinus has several turns and narrowings — this is all local resistance in fluid dynamics, which creates a pressure loss (gradient). Of course, you can say that it’s about the sensor’s sensitivity and so on… But I can tell you for sure that doctors are not engineers, and they don’t know many things about engineering.
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MRI is not informative.