uprightdoc wrote:Very interesting. I will review the findings again later when I get back from my swim. I suspect you may have issues with ischemia and edema.
What are your signs and symptoms? Do you have a history of significant trauma? Do you have a history of migraines with or without aura or other visual disturbances. Have you had any ultrasound studies of the carotid and vertebral arteries?
What are your signs and symptoms?
--- Bad Fatigue, spastic paraparesis, worse on the right and muscle
stretch reflex is diffusely hyperactive., visual blurring, visual tracking trouble (when looking to the left), Brain fog, slow thinking.
Do you have a history of significant trauma?
Do you have a history of migraines with or without aura or other visual disturbances
Have you had any ultrasound studies of the carotid and vertebral arteries?
#1 Pulsatile tinnitus, question angiogram
I have been asked to see this patient in cerebrovascular subspecialty consultation by Dr. for an
opinion about whether the patient should have a cerebral angiogram to exclude an arteriovenous cause of
his pulsatile tinnitus.
I went over the history of the pulsatile tinnitus with the patient, basically confirming what he told Dr.
. For more than five years he has had pulsatile tinnitus. He thinks he hears it mostly on the right
but perhaps somewhat on the left, although that is overshadowed and he is not sure it is pulsatile on the
left. Back at the beginning when he was still doing bike riding, he noted that when he would pull his head back
because his handlebars were quite low that the sound would actually go away for a day or
two if he rode a couple miles in that position. He also notes that if he turns his head to the end of the
range of motion to either side, the noise will increase briefly but significantly and then tail off to the
Overall it perhaps is somewhat louder over the five years but it does not disturb his sleep although he
does find it somewhat bothersome.
He had an MRA of the head and neck and an MRV of the head that have been reviewed here. They are
time-of-flight studies without gadolinium bolus. There is no obvious evidence of either an arterial
stenosis or an arteriovenous malformation on the study according to our radiologists. I have reviewed the
studies and agree. He does have a significant asymmetry of his deep venous drainage system with the
right being markedly dominant over a small left. Given the asymmetry and the size of the jugular
foramina, this is most likely a long-standing situation and less likely to be due to sequela of deep sinus
From the point of view of the pulsatile tinnitus, I told the patient that the only reason to pursue this with
an angiogram would be if the noise is so unacceptable to him (low probability) that a dural venous fistula
was identified that he would wish to opt to have a procedure to fix it. There is no other reason in the face
of a normal MRA to pursue an angiogram based purely on the pulsatile tinnitus alone, the cause of which
is not infrequently unknown even after cerebral angiography.
--- The tinnitus gets very quiet after soaking in a strong Mg foot soak for about an hour. It returns slowly over the following hours.
And the strong niacin flush makes almost everything much better for 20-30 minutes.