The MRI shows that you have enlarged anterior scalene muscles and the longus colli muscle. But this doesn’t confirm anything 100% yet.
drive google com/file/d/1SP43QJywH9391Tl4VGBAzA-pNdLPU2HZ/view?usp=sharing
Of course, a lot can be assumed and speculated about (including compression of the vertebral artery). But this MRI is not enough to say anything with certainty. It cannot be guaranteed 100%.
It could be, but I explicitly told the doctor that I needed the pressure gradient. In any case, in the email I sent her, I’m asking, among other things, about the pressures measured at each position and at each measurement point.
I’ll have another imaging study that will allow them to assess the relationship between C1 and the surrounding structures during movement, with the aim of also identifying a possible mechanical cause for my symptoms.
The venography report mentions stenosis in the right vein, but on the left it says that no stenosis was seen. It’s very strange, because the left IJV is the one that appears to be more compressed on the CT
Take a look at the MRI scan above. I’ll ask you again. If you do a CT scan with a dynamic test (head rotation) and see decompression or compression of the IJV, what will that give you? And what will it give the doctors?))))
And again, on DSA venography with head rotation, this may already be visible.
What if there is a mechanical cause in addition to the vascular compression??
I asked the doctor:
To find out which direction my head was turned during the pressure-gradient measurement for each IJV (whether it was turned toward the same side as the vein, toward the opposite side, etc.).
To find out exactly where the pressures were measured to calculate the gradient. I assume it was above and below the stenosis, and I’d like to know the value measured at each point.
To find out whether an absolute pressure measurement was ever taken in the transverse venous sinuses and how it changed with head rotation.
The images in their original format.
You don’t need a pressure gradient (doctors have problems with such complex measurements), but simply intracranial blood pressure in the transverse venous sinuses.
But I would advise you not to rush into surgery and to get a proper diagnosis first.
And you might be experiencing symptoms due to the vertebral arteries; nothing is clear yet, and there’s no guarantee that all your symptoms are solely due to the veins (I’m not talking about pain now).
I’m more than sure that they didn’t measure the pressure, and the protocol is a fiction.
I asked her about the intracranial pressure in the transverse venous sinuses.
But it’s C1, not the styloid process, that is compressing the IJV, right? So perhaps removing only the styloid process wouldn’t work.
For now, I don’t want surgery until I know exactly what is going on, both neurologically and vascularly
You recommend an arterial DSA and a vascular Doppler ultrasound to measure blood flow. But I need to know exactly what I should tell the doctor when requesting these tests, including the reason for them and how you would like the tests to be performed
So you think they calculated it from the images rather than measuring it with a catheter? I assume she’ll clarify that when she responds to the questions I asked her
Yes, I think they didn’t measure the pressure. They did a regular DSA venography with head rotations. And they saw that the contrast passed through the local area of compression, and they interpreted this as meaning you don’t have any problems with the veins. But…
Just start by doing the Doppler scan correctly, making the correct measurements of the volumetric blood flow velocity. This is safe and inexpensive.
But you need to understand that this will be additional information. And a Doppler diagnosis doesn’t oblige you to have surgery; it’s just additional information. Doppler is not a diagnostic method that doctors use to make decisions about surgery. Also, the speeds are more likely to be incorrectly measured.
Arterial Doppler:
Measure volumetric blood flow (mL/min), not just velocity.
Measure it on a straight segment of the vessel, never at a curve or bend.
Use manual angle correction in the ultrasound machine’s software.
Also record the Doppler waveform/spectrum and vessel diameter at the measurement site.
And a Venous Doppler
Yes/
).I remember that in several consultations they performed ultrasounds and told me that the venous blood flow was normal.
This is the report from one of those appointments:
Vascular:** Arterial TSA: truncal pulses present; upper extremity pulses present.
Adson maneuver + arm hyperabduction + head rotation: Normal. No changes in the pulse waveform were observed.
Doppler ultrasound: T/B index.
TSA Doppler ultrasound: Normal B-mode findings; mean CIMT ≤ 0.9 mm. ICA/CCA PSV <120 cm/s; right vertebral artery dominant and antegrade.
No extracranial pathology of the TSA truncal vessels was observed.
I don’t need a report. I need values in ml/min and cm/s, with a scale, and images of the spectrum (waveform).
Here is an example of screenshots, preferably in DICOM format, or a screen shot. A photo is not good.
drive google com/file/d/1AWFckoOQVOy68YNZLP6BUAI0A-BUA61U/view?usp=drive_link
There is also a difference in the maximum volumetric flow rate, the average, and the average over time (Tamean ). There will be different numbers, different values.