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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: daughter's MRA- NF-1Forum: Neurology Forum
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Hello! My daughter is 10 and has NF-1. She has been having headaches almost every day for quite a while. She had a brain MRI (she has had several of these since dx of the NF about 2 years ago).She also had an MRA . THe MRI was reported as normal. The MRA showed the following-- "...poor flow in both anterior and middle cerebral arteries. Images of the posterior circulation demonstrate better flow than seen in the anterior circulation though again there are some areas of narrowing and less than expected flow, worse so in the right posterior cerebral distribution than the left." THEN the radiologist goes on to say that this is felt to be artifactual as there is no definite abnormality seen within the brain on MRI . He says that if there is strong suspicion of a vascular abnormality then a cerebral arteriogram should be done. Her neurologist is going to look at this and we haven't heard his opinion on it yet. SO my question is-- should we have someone else that is more experienced with nf look at the films too? I (her mom) am going to Cleveland Clinic to see 3 of the docs there this next week for CNS lupus-vasculitis and associated problems. I know that you have some doctors there that specialize in NF. Would they look at my daughters MRA- and read it and give their recommendations without seeing her? She isn't planning on coming with me. I don't want to let this go without making sure that we know for sure that there isn't a vascular problem there since she is having these bad headaches all the time. Thanks so much for your time---!! Dear Ruth: Sorry to hear about your daughter. Yes, we have a big neurofibromatosis population that we follow. What sounds like some narrowing on the MRI in the anterior circulation is not uncommon in NF. The big problem with just looking at the films (which we could of course do) is that legally there are problems. Not that you would sue or anything but without an official visit, the comments could lead to legal issues. What I would do is to wait and have your pediatric neurologist look at the films with a neuroradiologist. If there is still some concern then have a transcranial doppler performed, this test will note blood velocity through the arteries and therefore if there is strictures. What we like to do, is get a baseline angiography of the cerebral vessels and MRA, then we have a comparison to follow. We then will follow routinely (usually, yearly) with TCD or transcranial doppler to follow possible changes in blood flow. I am not sure what your pediatric neurologist likes to do, but you need to discuss Sorry, I am sure this is not the answer you wanted to hear. The issues of medical care are beginning to be more legal than medicine. Soon, if doctors start to act like business men and women, we are all in big trouble. So, the answer is get your pediatric neurologist to look at the MRA with a neuroradiologist and come to a decision. It is my guess that an angiogram and TCD are needed. Best of luck, let us know if we can help officially. Sincerely, CCF Neuro[P] MD
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