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Neurology (Expert Forum)
Could this be Vertebral-Basilar Insufficency
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Could this be Vertebral-Basilar Insufficency
by Iron Fingers, Feb 10, 2004 12:00AM
I don't know if what I have is vetebral basilar insufficency. I am not getting any answers from the neuro-resident I Have been seeing. It seems like he does not have the time to talk to me. I don't know if I should take the CT/Angiogram to another radiologist for a second opinion, or if I should just go to another neurologist with the films and get his opinion. I know all of this has me very concerned and scared.
My PC Provider that I have been seeing at the VA for the past 7 years just retired. I have been assigned to a Physician Assistant who is obviously burned out from patient overload and has not been of any real help.
About six months ago I started having episodes of vertigo, blurring of vision, ringing in my left ear, nausea and weakness in my left arm and leg. These episodes lasted from 5-10 minutes then slowly went away. The ringing in my ear has been present since the first episode. I seemed to be having 2-3 episodes a week. Each episode seem to get worse. I tried to put this off as from being tired.
After several weeks of these episodes I decided to see my PC Provider. After completing his exam, he told me that he was concerned about the residual weakness he noted during his exam and wanted me seen by a Neurologist at the VA Hospital.
About 4 weeks later I was seen at the VA Hospital by a neuro-resident. After taking my history and brief exam he told me that I was having what is called a "migraine equivalent" and wanted to start me on a low dose of Elavil. After taking this medication for two weeks I did not notice any change. The episodes seem to be getting worse. Besides the vertigo and weakness I was now having severe light sensitivity, visual (lights jump & streak when I move my eyes)disturbances, and hyper-hearing sinsetivity. The last two complaints have been continuous for the past 4 months. I went back to my PC Provider and he had me seen the next day.
The Resident did another neurological exam and told me he was going to request a CT/Angiogram. Six weeks later the CT/Angiogram was done.
The report is as follows:
Clinical Hx: 56 y/o male with episodes of vertigo and left sided weakness, blurring of vision. please eval posterior circulation
Exam: CT & CTA of circle of willis.
Findings: The CTA demonstrates a complete circle of willis. There appears to to be fetal origin of the PCAs bilaterally. In addition, there is a diminutive basilar artery originating from a dominant left vertebral artery. The basilar artery in greatest dimension measures approximately 2 mm. No significant atherosclerotic disease is demonstrated.
The remainder of the circle of willis is intact without evidence of aneurysmal dilitation or significnt disease. There is a dominant left A1 segment.
No acute intrcranial process is identified.
Impression:
1. Entire circle of willis is demonstrated without evidence of aneurysmal dilitation or significant atherosclerotic disease.
2. Fetal origins of the PCAs bilaterally is noted. This is associated with a diminutive basilar artery, as above.
3. Dominant left A1 segment.
I am not sure why nothing was mentioned in the report about the right vertebral artery.
About 4 weeks after the CT was done the neuro-resident called me at home and informed me of the findings and stated he would get back with me on treatment. 3 weeks later he called me and said he was going to start me on Plavix and a 81mg. aspirin.
I started the Plavix and aspirin treatment but after 2 weeks on the Plavix I developed a bad rash(uticaria) and had to stop the Plavix.
I went back to the VA clinic to see my PC provider and was informed that he had retired. I was seen by a Physician Assistant and he told me to stop the Plavix and start taking a 325 mg. aspirin daily.
I tried taking the 325 mg. of aspirin daily but continued to have the episodes of vertigo and weakness. I have increased the aspirin dosage to 975 mg. daily and have not had a recurrence since. I do have some residual of which I have noted below.
1. Continuous ringing and hum in my left ear.
2. Continuous(when it is quiet) hearing my pulse in my right ear
3. Intention tremor left hand
4. Light sensitivity
5. Visual (lights seem to jump and streak when I move my eyes) disturbances
6. Hyper-hearing (most all noise hurts my ears) sensitivity
7. Weakness with my left hand and foot.
I have called the neuro-resident to schedule an appointment to answer some of my questions and to find out if there is other medication I can take besides Plavix, and do I have to worry about the size of the basilar artery now or as I get older. I also have concerns about the residual noted above.
My question to you is: 1. Could this be Vetebral-Basilar Insufficency?
2. Should I get a second opinion?
v/r
JD
My PC Provider that I have been seeing at the VA for the past 7 years just retired. I have been assigned to a Physician Assistant who is obviously burned out from patient overload and has not been of any real help.
About six months ago I started having episodes of vertigo, blurring of vision, ringing in my left ear, nausea and weakness in my left arm and leg. These episodes lasted from 5-10 minutes then slowly went away. The ringing in my ear has been present since the first episode. I seemed to be having 2-3 episodes a week. Each episode seem to get worse. I tried to put this off as from being tired.
After several weeks of these episodes I decided to see my PC Provider. After completing his exam, he told me that he was concerned about the residual weakness he noted during his exam and wanted me seen by a Neurologist at the VA Hospital.
About 4 weeks later I was seen at the VA Hospital by a neuro-resident. After taking my history and brief exam he told me that I was having what is called a "migraine equivalent" and wanted to start me on a low dose of Elavil. After taking this medication for two weeks I did not notice any change. The episodes seem to be getting worse. Besides the vertigo and weakness I was now having severe light sensitivity, visual (lights jump & streak when I move my eyes)disturbances, and hyper-hearing sinsetivity. The last two complaints have been continuous for the past 4 months. I went back to my PC Provider and he had me seen the next day.
The Resident did another neurological exam and told me he was going to request a CT/Angiogram. Six weeks later the CT/Angiogram was done.
The report is as follows:
Clinical Hx: 56 y/o male with episodes of vertigo and left sided weakness, blurring of vision. please eval posterior circulation
Exam: CT & CTA of circle of willis.
Findings: The CTA demonstrates a complete circle of willis. There appears to to be fetal origin of the PCAs bilaterally. In addition, there is a diminutive basilar artery originating from a dominant left vertebral artery. The basilar artery in greatest dimension measures approximately 2 mm. No significant atherosclerotic disease is demonstrated.
The remainder of the circle of willis is intact without evidence of aneurysmal dilitation or significnt disease. There is a dominant left A1 segment.
No acute intrcranial process is identified.
Impression:
1. Entire circle of willis is demonstrated without evidence of aneurysmal dilitation or significant atherosclerotic disease.
2. Fetal origins of the PCAs bilaterally is noted. This is associated with a diminutive basilar artery, as above.
3. Dominant left A1 segment.
I am not sure why nothing was mentioned in the report about the right vertebral artery.
About 4 weeks after the CT was done the neuro-resident called me at home and informed me of the findings and stated he would get back with me on treatment. 3 weeks later he called me and said he was going to start me on Plavix and a 81mg. aspirin.
I started the Plavix and aspirin treatment but after 2 weeks on the Plavix I developed a bad rash(uticaria) and had to stop the Plavix.
I went back to the VA clinic to see my PC provider and was informed that he had retired. I was seen by a Physician Assistant and he told me to stop the Plavix and start taking a 325 mg. aspirin daily.
I tried taking the 325 mg. of aspirin daily but continued to have the episodes of vertigo and weakness. I have increased the aspirin dosage to 975 mg. daily and have not had a recurrence since. I do have some residual of which I have noted below.
1. Continuous ringing and hum in my left ear.
2. Continuous(when it is quiet) hearing my pulse in my right ear
3. Intention tremor left hand
4. Light sensitivity
5. Visual (lights seem to jump and streak when I move my eyes) disturbances
6. Hyper-hearing (most all noise hurts my ears) sensitivity
7. Weakness with my left hand and foot.
I have called the neuro-resident to schedule an appointment to answer some of my questions and to find out if there is other medication I can take besides Plavix, and do I have to worry about the size of the basilar artery now or as I get older. I also have concerns about the residual noted above.
My question to you is: 1. Could this be Vetebral-Basilar Insufficency?
2. Should I get a second opinion?
v/r
JD
Doctor's Answer
by CCF-Neuro-M.D.-CS, Feb 11, 2004 12:00AM
Your symptoms could be consistent with either vertebral basilar insufficiency (VBI) or migraine variant. The CT angiogram did not prove that your basilar artery is abnormal. In most individuals the posterior cerebral arteries are supplied by the basilar artery, and typically one vertebral artery is dominant. However, in some people the posterior cerebral arteries are supplied by the carotid arteries (this is the way the circulation is as a fetus). If this is VBI the treatments include either aspirin, a combination of aspirin and plavix, or coumadin (a blood thinner). However, the dose of aspirin you are taking is not clearly better then just 325mg. There are no current studies proving higher doses are better, and the side effects are more severe (GI irritation). You should discuss these options with your doctor. Also, if you are concerned about the care you are receiving from the resident, he/she is supervised by an attending physician who you can ask to speak with. If you are not happy with their response, then a second opinion would be reasonable. You should also ask your physicians if a conventional angiogram is indicated. Good luck
