2mm Right Supraclinoid ICA Aneurysm

Hi everyone!

I'm 22, female. I'm not sure if your symptoms are exactly the same or not, but I've been suffering from something similar for two weeks now.

I'm generally very coordinated and have good balance, but following a chiropractic manipulation of my neck on Tuesday 4/27/10, I have been having puzzling symptoms. I've been to this chiropractor sporadically since October 2008, and she's always used tools to gently adjust my spine, but never before has she done a manipulation like this: she had an assistant pull on my legs, while she pulled on my neck and twisted it hard and fast to one side.

Later that night, I was nauseous. And that night while trying to get comfortable and fall asleep I whipped my neck violently up and down against my pillow (a sort of whiplash effect). I woke up feeling fine the next morning, Wednesday 4/28, but later that day I noticed my vision was slightly blurry or distorted.

Sometime soon after the 28th, dizziness started. Not vertigo, not spinning, but a feeling of imbalance, not being able to walk well (like I didn't know how far the ground was when putting down my foot), and the sensation that somethings were distorted in my vision, sort of curved, and moving strangely or more than they should be.

After a while pressure began building behind my right eye, and from time to time I have muscle tension on my right neck (the same side as the eye pain and pressure), my head hurts especially when I lay down and there is pressure on it from the pillow/bed. Sometimes I'm nauseous and I vomited a few times last week. I feel like I have trouble holding up my head, like it's heavier on the right side. My dizziness is worse when I'm standing and walking, but the dizziness can be triggered by rolling over in bed, getting out of bed, and looking up by tilting my head back. Again, it's not spinning like vertigo, but just unsteadiness like things are moving more than they should.

It's been over 2 weeks now and the symptoms may have fluctuated a bit from day to day, but they are constant and haven't gotten any better that I can tell.

I've been to the Emergency room twice, neither time they found anything wrong. I've also been to my general practitioner who send me to the second emergency room trip to have an MRI of my neck and head done because she feared that an artery in my neck had been torn because of the chiropractic adjustment and that I might be bleeding into my brain, and might have a stroke.

I have seen a neurologist who basically laughed in my face and said you haven't had a stroke yet, nothing's wrong with you neurologically. I saw a spine doctor who said my spine had no problems, it wasn't misaligned, and they could tell why I might be dizzy all the time.

I finally got the results of the MRI of my head and and I don't have a torn artery in my neck, and everything's normal EXCEPT for a "2mm right supraclinoid Internal Carotid Artery aneurysm, projecting inferiorly" which I've figured out from searching online is a brain aneurysm behind my right eye near the optical nerve. It's unruptured, and small so the likelihood of it rupturing anytime soon is small, but I don't know if it might be causing symptoms.

Could this small aneurysm in my brain be causing the eye pain and pressure behind my right eye, visual disturbances, imbalance, disequilibrium, nausea, occasional neck pain, unsteady gait (walking), and fatigue (I'm so tired all the time, and this is not normal for me)?

Do you guys know anyone who's had an unruptured brain aneurysm?

Do you know what might have caused it?

Do you guys think that my chiropractor's manipulation caused the aneurysm to form?

Thank you in an advance for any responses.

[HumanNature]

Also, the report for my MRI said I have a fenestrated ACOM.
Does anyone know what this means and if I should worry about it?

[Eddie1994]

ACOM is the abbreviation for the Anterior Communicating Artery.

As I was about to write about my wife's experience regarding your first set of questions, I looked up your second set.   You need to have a second conversation with your Neurologist.  ACOM is very nearby the optic artery.  I know this from reviewing my wife's Neurosurgeon's Report of Operation whereby he notes the proximity of her anneruysm to the nerve and references its location on the Left Communicating Artery.  By the way, think of anterior as towards the front of your head.  

It sounds as though the aneurysm could be pressing on the optic nerve since you describe some relevant symptoms and medical literature references this as well.  You were likely born with this defect and there is a subset percentage of patient who have one aneruysm also have another or more.  Again your Neurologist can inform you more about this.  You are fortunate in that your aneurysm has not ruptured and have time to get a plan going forward.  I don't sugar coat things because this serious business and you can't go forward thinking "well maybe nothing will happen" because at some point it will.  My wife was only two years older than you when her formation period began and eight years later her aneurysm burst.  I write this I would also suggest that you also consider three more things as follows:

1) Make sure you have health insurance going forward that covers not only Doctor visits but also testing, surgery, rehabilitation and disability insurance.  I state this only for your future protection since I and my wife have been down this road and I personally know another female who suffered a similar rupture.

2) Make sure you have personal affairs in order such as "Powers of Attorney" both durable and medical, and any other affairs that you think need to be considered.  You may want to consider a family member you can trust and count on if  a bad situation develops.

3) Even if you start feeling better (and my wife did for about seven years) make sure you stay on top of this condition as if your life depended on it.  

There are options for you and a good hospital system that specializes in this will help you.  Again, tell your Neurologist about your symptoms and that you prefer to plan ahead rather than watchful waiting.  Two mm may be on the lower scale (5mm is usually when surgery is warranted for other aneruysms) but this is in your brain.

My non-medical opinion is that the Chiropractor did not cause this.  Look at it this way, he/she may have brought to light something that may not have been discovered until it was to late.  Good luck and feel free to ask any other questions.  P.S.  I have written about our experiences in this forum and in the migraine section.  Look for Eddie1994 and I hope these notes will help you more.

[HumanNature]

Hi Eddie!

First of all, thank you so much for taking the time to form a thoughtful response. I really appreciate it. I'm sorry to hear about your wife's aneurysm; it's a scary thing to face. I will surely look for your other posts, and read about your wife's situation. I will definitely take all of your tips to heart re: medical insurance, personal affairs, and lifestyle.

I saw a neurosurgeon this morning, and he looked at the MRI images I took on the 5/6/10. He said he saw the place where the radiologist reported my aneurysm and he said that it was close to where another vessel started (a bifurcation), so it might not even be an aneurysm at all. Apparently, when MR angiograms can sometimes give false positives on aneurysms when they are small. However, he couldn't say either way whether or not it existed. He didn't think it was causing the pressure behind my right eye because the optic nerve is above the supraclinoid ICA and mine is protruding DOWN. He also thought it would have to be bleeding to be causing my symptoms of imbalance etc.

I'm not sure what to think now. I'm thinking I'm gonna have to go get a second opinion and think about whether to double check the existence of this aneurysm with a standard "catheter" angiogram, which is really scary, and carries risks of causing a stroke in itself...

Hypothetically, if the chiropractor pulled on the Carotid Artery while twisting my neck, couldn't it have placed stress on the the ICA higher in the head, causing it to stretch and weaken? What do you think?

Any ideas on what else could be causing these symptoms?

I'm going to go read your wife's story, and get back to you with questions specific to her case, if you don't mind. :)

Thanks again!

[HumanNature]

Oh, and I'll have to look into the ACOM, thanks for the info on it.
I'm not sure what fenestrated means, and I should definitely ask a neurologist about that.

[HumanNature]

Hi again, Eddie!

From what I understand, your wife suffered from migraines for 7 or 8 years before an aneurysm that she didn't know of ruptured? Were the headaches her only symptoms?

You said she felt better for 7 years-- does this mean her symptoms bothered her for a short time, then disappeared, and then returned leading up to the rupture? Or did they come and go?

So far, I haven't had any headaches. Just when I lay down, and the back of my head is touching my pillow, it hurts my head and my neck sometimes.

How is she doing now?
Do you know about standard angiograms (with the catheters?)
What foods/activities should be avoided to stall growth and prevent rupture as much as possible?

Hope you have a good day!

[HumanNature]

Eddie: I'm so sorry to flood you with questions - it appears it's impossible to edit your posts after you hit "submit" on this forum. I saw you mention a "silent migraine" in another thread - what is this? And could I possibly be having them? I've not had a headache, but I've had dizziness, imbalance, eye pressure and things that are often said to go with migraines starting 2 weeks ago...perhaps these are part of an independent 'aura' followed by a painless migraine? Would this more likely suggest that the aneurysm is causing my symptoms?

[skydnsr]

I've read all your posts.  I'll give you my "take" on your symptoms, for what it's worth, which might be nothing.  I'm not a doctor of any kind.  But this is how it seems to me, just from stepping back and trying to look at the picture as a whole.  

You got injured by an excessively forceful chiropractic adjustment.  That is the most parsimonious explanation of your symptoms, based on the information you have provided.  Maybe you have some swelling and inflammation that has spread through the tissues up into your head.  That would be consistent with the onset of symptoms occurring the next morning and then symptoms gradually worsening over the next few days.

If it were me, I would be taking over-the-counter anti-inflammatories and using conservative measures such as damp heat to try to get over that, before I got overly concerned about the possibility of some kind of rare abnormality deep in my brain.  Maybe you should even consider asking your PCP if a brief course of oral prednisone or something like that might help with the neck injury.  If it does, then I doubt even more that your symptoms are due to an aneurysm.  Maybe you could even try a neck brace, to try and rest your neck muscles as much as possible.  Maybe some physical therapy.  I'm just brainstorming, here.  

The neurosurgeon who looked at your MRI is not even sure that an aneurysm exists, and he should be the most qualified person to say.  Personally, I would hold off on chasing something exotic, at least not until more mundane measures to treat the acute neck injury have run their course.  I'm thinking, what are the chances that your "real" problem is an aneurysm, when none of the symptoms prompting you to have the brain scans emerged until shortly after your chiropractor did what she did?  

I would just treat it as an acute injury with swelling and inflammation.  That's just me, but there's an old saying in medicine:  when you hear hoofbeats, think horses -- not zebras.  Maybe you will want to see what happens over the next few weeks with conservative treatment for a neck injury.  If you have no improvement, you can always pick back up with the stressful and expensive tests, later on.

Good luck.

[HumanNature]

Hey there! Thanks for your advice,again. :) I'm hoping it's just muscle strain that's causing these symptoms, but they are so strange. I'm not getting any headaches, and neck pain is transient and comes and goes, it doesn't really feel like anything was pulled except for here and there. And the neck strain wasn't there right away, only after a few days. I'm hoping with some physical therapy, stretching, and time the symptoms will go away, but what if it's the aneurysm that's causing all this...will the symptoms then be permanent? And if the aneurysm is present--is physical therapy safe, or could I possibly rupture it from too much activity in the head/neck region?

[HumanNature]

Sky - another question.
What do you think of trigger point theory?
I'm not sure I understand exactly how it works.
Is it possible, in your mind, that I could have strained the SCM muscle or other muscles in the neck, and it doesn't hurt the SCM muscle, but refers pain to behind my right eye, blurs my vision, and causes imbalance?

[skydnsr]

In regard to your question about whether physical therapy is safe in your situation -- PT has to be prescribed by a doctor, so if the doctor prescribes it, then he or she thinks it is safe.  The safety and appropriateness of it is something that your doctor and physical therapist will have to assess.  Even if the doctor prescribes it, the physical therapist will not proceed if he or she thinks it is unsafe.

In regard to your other questions, I just don't know.  This is a really weird injury.  We may never know all the exact answers to what happened and how.  But if you can get well from this, then the details may not matter in the long run.  If worst comes to worst, and the visual symptoms persist longterm, then you are going to have to go back to more testing and more looking for unlikely answers.  

So far, the brain imaging has not come up with anything definite.  There is only a "possible" aneurysm -- which if it even exists, according to the neurosurgeon, does not look as if it could have caused your symptoms.  If we did a brain MRI on everyone in the population, probably lots and lots of people who are totally asymptomatic would come up with findings like this.  

To me it just seems as if the main fact is that these problems with your vision started shortly after the nonhelpful chiropractic adjustment.  Does that make sense, or am I missing something?

[HumanNature]

You got it. The vision problems started the day after the chiropractor visit. So I'm sure she had something to do with it -- the question is what? Did she strain my neck muscle, or something bigger, like cause the aneurysm to form or cause it to grow? I'm just trying to put the pieces of this puzzle together...it's so frustrating having these symptoms that may just be benign but are so uncomfortable & I don't know what to do to fix them.

Have you ever been dizzy and had vision problems for extended periods of time?
If so, for how long & did you ever figure out the cause?

[Eddie1994]

Sorry for the delay in getting back to you, I usually take Saturday's off from the web.

The two opinions certainly null each other in so many ways.  Skydnsr has very good points as well since timing is a good clue.  May I suggest you seek an opinion from a medical center that specializes in aneruysms.  Thomas Jefferson and Cleveland Clinic come to mind if you lived in the region I live in, but there are so many more around the Country.

Because of an early morning appointment I can't go into much detail tonight but will try tomorrow.  Regarding angiogram it would be the definitive answer but it is invasive.  My wife would have another "if it was necessary."  As far as diet, anything that would keep blood pressure in the lower range would be helpful, i.e. reduced salt, etc.  If you are a smoker consider quiting, it has an effect on blood vessel pliability (for lack of  a better word at the moment.)  Also, creating pressure in the head by lifting objects such as a weight lifter, would be a bad idea.

My wife only symptoms were the thunderclap headache followed by dizziness, vomiting, hearing disturbances, and kalidiscope vision.  By then the damage was done.  The headaches/migraines 7-8 years earlier is a definitive but subjective finding.  Her CT scan at that time showed nothing growing, but I believe we can subjectively conclude that something was developing at that time.  

[Eddie1994]

At my wife's medical appointment this morning we saw her CT scan of a kidney stone that caused a pain attack about ten days ago.  She has subsequently passed it, thank God!

The size of the stone was 1.6mm.  It got me thinking about the size of your 2mm potential anneruysm.  The size looked small physically, but size is relative to something.  Here is what I mean.  If it was a small broad bulge that projected 2mm that one thing, but if it projects 2mm like a "pin head" or "pimple" that's entirely something else.  Such a projection would have a more dire consequence should it burst.  The brain dosen't respond well to blood outside the vessel.  It is for this reason that you should explore and be satisfactorily convinced that you should be "less" concerned at this time.

It's not a pleasant thought to have further medical consults but????  Here is one more thought you could discuss with a third neurosurgeon - would a stent be a viable option if it is a anneruysm?  I was surprised that stents were used in this manner and my wife certainly would have had a different neuropsycological outcome if this option were available at the time of her surgery in 1994.

I hope you find these comments helpful.  Please understand they are offered out of an abundance of care.  Good luck and let me know if you have any additional questions.  

[68suezq]

i have read all this and i know some one with an anerism behind the eye. he has had it for many years. now he is 73. he does have dissy spells and some headaches. i dont think your symtoms (symptoms) are coming from that . you said they started after the ciropracter. ( i did see where you said it might not be an anurism) any way i know what you are talking about when you descibe your symtoms (symptoms). i also saw a chiropracter years ago. i had the turning of the neck thing done to me. i didnt feel so hot either. i felt like my head was real light.almost erie feeling. the chiropracter was makingme worse so i quit going. i had pulled muscles in my neck. when he turned your neck he my have agravated something but dont worry it will eventually get better. if he did somthing real bad you would not have been able to walk out his office. you probly have some swollen musclesect...  i also went back complaining of pressure in my head. i only noyiced it when i had a lot of popping noises. i asked what those popping noises were. he said it was air trapped and when he ajusted my neck it would release. thats when i would feel pressure. i felt it for a while. i would say on and off for 3 to 4 weeks.  maybe thats what you are feeling.and like i said dont worry  he can ony turn your neck so far  so if he did cause some swelling by turning your neck then it will take weeks to feel better. take antiinflamitories. take a hot bath befor you go to bed. also ask chiropracter about the trapped air.  good luck sue  if you need to ask me any thing leave me a note

[HumanNature]

Thanks for the advice & taking the time to go into more detail.

I went to another neurologist yesterday morning, within the same medical group that did my MRI, to see if they could review the findings with me, but the doctor told me that he just read the report, and didn't really want to look at the MRI because he said only a radiologist could properly see something so small. When I asked him to please take a look, he left the room, and came back saying he couldn't see it. He was also convinced that the aneurysm was too small to cause my symptoms, but I'm not sure if I'm convinced. I have an appointment with a neurointerventional radiologist on June 1st, but that's so far away, and I don't feel like I'm getting any better.

As far as that upcoming appointment goes, do you think he will be able to look at the MRI with me, point to exactly where it is, and know with more certainty that it is or is not there? Just not knowing is driving me crazy. I'm very scared about the risks of angiograms - could cause a stroke all on it's own. It would be really upsetting if there was nothing there, and I was put through an invasive & dangerous procedure.

Were your wife's migraines 7-8 years prior to the rupture continuous throughout the 7-8 years? Or did she have migraines for a period all those years ago, and then nothing until the onset of symptoms leading up to the rupture? What kind of dizziness did your wife experience? What is meant by kaleidoscope vision?

Also, I'm not getting headaches, just pressure behind the eye which is where I believe the aneurysm is. I've read that there are saccular aneurysms and those sort of protrude like berries on a stem. I'm not sure if that's what's going on for me. Are you saying that if this were the case it would be more likely to be touching some structure in my head causing my symptoms?

The weird thing about this is that I don't really have headaches. But I've never been prone to them.

Thanks for your help. I look forward to your response. :)

[HumanNature]

Thanks for the advice & taking the time to go into more detail.

I went to another neurologist yesterday morning, within the same medical group that did my MRI, to see if they could review the findings with me, but the doctor told me that he just read the report, and didn't really want to look at the MRI because he said only a radiologist could properly see something so small. When I asked him to please take a look, he left the room, and came back saying he couldn't see it. He was also convinced that the aneurysm was too small to cause my symptoms, but I'm not sure if I'm convinced. I have an appointment with a neurointerventional radiologist on June 1st, but that's so far away, and I don't feel like I'm getting any better.

As far as that upcoming appointment goes, do you think he will be able to look at the MRI with me, point to exactly where it is, and know with more certainty that it is or is not there? Just not knowing is driving me crazy. I'm very scared about the risks of angiograms - could cause a stroke all on it's own. It would be really upsetting if there was nothing there, and I was put through an invasive & dangerous procedure.

Were your wife's migraines 7-8 years prior to the rupture continuous throughout the 7-8 years? Or did she have migraines for a period all those years ago, and then nothing until the onset of symptoms leading up to the rupture? What kind of dizziness did your wife experience? What is meant by kaleidoscope vision?

Also, I'm not getting headaches, just pressure behind the eye which is where I believe the aneurysm is. I've read that there are saccular aneurysms and those sort of protrude like berries on a stem. I'm not sure if that's what's going on for me. Are you saying that if this were the case it would be more likely to be touching some structure in my head causing my symptoms?

The weird thing about this is that I don't really have headaches. But I've never been prone to them.

Thanks for your help. I look forward to your response. :)

[HumanNature]

Hi Sue.
Thanks for your response. The man you know with the aneurysm behind his eye: do you know how often he has dizzy spells & headaches, and how long they last, and what type of dizzy it is? Is is spinning, or just hard to balance?

What did the chiropractor do to you? What were your symptoms afterward? Were they constant? When did they go away? How did you know it was muscle, and did you do anything to heal?

Thanks again Sue, I look forward to your response.

[Eddie1994]

HumanNature,

No the headaches subsided sometime after the first CT scan.  Up until the burst she really had no headaches or other symptoms that weren't self induced (occassionally imbibbing moderately).  The neurointerventionist is a good idea, but try not to worry until then.  The kaleidoscope vision was just like looking through a prism.  It lasted for at least an hour after the burst.  I suspect that with the optic nerve close by, either the blood or the resulting cranial pressure caused the visual disturbance.  The dizziness involved gait.  We can't say if it was due to the visual disturbance or some other reason. Also she had a relatively loud noise in her hearing.  I do remember her calling me and it was difficult for her to see the handset numbers.  Because I was 65 miles away at the time, I got her calmed down enough to call a nearby neighbor whom she new.  They immediately called 911 and I was on the ride of my life.

With respect to the Neurologist, he/she may not have felt very comfortable or had extensive experience reading MRI films.  I do know that some medical systems require their Doctors for  follow a protocol to avoid medical malpractice.  I've experienced this with my Dad's Oncologist who is a Doctor in a teaching hospital.  It's probably a good practice but the waiting seems interminable.

[HumanNature]

Eddie, thanks for the clarifications.
I'll try not to worry about the aneurysm until my June 1st appointment.
More than that, though, I'm afraid these undiagnosed symptoms I'm experiencing are not going to go away anytime soon, as they haven't let up for 3+ weeks. I don't know how to treat it since I don't know what it is.

So your wife had a period of headaches lasting for how long 7-8 years ago?
Weeks, months?

I was in a teaching hospital clinic, and both the "student" and the "teacher" were in the room with me. It was the "teacher" who didn't want to read the MRI again, and who couldn't quite tell me where exactly the aneurysm was, nor could he see it upon inspection. It really didn't ease my mind in the least.

Do you know anything about other things that could be causing imbalance (disequilibrium) or eye pressure? Or people I might speak to/ communities online I might use that could help me figure this out?

You've been a great help.
I can't say thanks enough.

[Eddie1994]

HumanNature,

As I recollect now the headaches seemed to come and go and the period lasted months.  I remember we were at the shore for a long weekend and had to leave the same day we arrived, my wife,then my long-time friend, was really scared.  When we got home, we talked with a neighbor who was a surgical room nurse about her headaches.  My wife was worried she had a brain tumor.  She had the CT Scan a few weeks past that time.  It showed no identifiable tumors or other pathologies for that matter.  That's why I now suspect the vessel was beginning the process of stretching and forming the aneruysm.  As I understand it and many times feel it when my blood is drawn, blood vessels can initiate pain signals.

The only other potential source of the imbalance could be vertigo.  My Mom had such an attack last year.  I rushed her to the hospital because the symptoms mimicked a stroke and she had imbalance, slurred slow speech, etc.  I just look back at your original symptoms and you thought that it was not vertigo - Was this ruled out by your Doctor?.  If you have noise in your inner ear then you might want to rethink the vertigo.  

As for the student and the teacher leaving the room, I wonder if there was not an uncomfortable feeling due to a lack of knowledge.  Your next appoinment should be more helpful to you.  Time also seem so fleeting until you need an answer quickly.  Then the wait seems interminable!

[HumanNature]

I see. I have no had vertigo ruled out by a doctor, but this imbalance feels more like rocking on a boat. There is no spinning involved. I feel like I'm rocking when I walk. If the neurointerventional radiologist ensures me that the aneurysm has nothing to do with my symptoms--my next stop will probably be a neuro-otologist to see if it's something inner ear related.

Do you think muscle tension in the neck could cause all of this?

Now that you bring up, I've been experiencing a strange tugging sensation in the front of my neck, sort of diagonally. It is only brought about when I push on the back of my neck where the spine meets the skull, and sometimes there is a heart burn type sensation in my throat. Do you think this has something to do with blood vessel obstruction, nerve pinching, or just muscle strain?

I know you're not a doctor, but any personal opinion on this matter will do.

I just don't know what to think these days.

Hope you and your wife are doing well, Eddie.
Thanks for the support.

[Eddie1994]

HumanNature,

Sounds like a good plan.  You did mention that a Chiropractor performed a manipulation but of what I wasn't sure what that was about.  They are helpful I guess but I can't use the services they provide.  Maybe  the heartburn has something to do with that.  I wish I could be more helpful.  Let the community know what the interventionist found.