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vertebral artery occlusion
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vertebral artery occlusion

Hello, I had an MRA of my brain and was diagnosed with an occlusion of my right vertebral artery.  My PCP seems to think it's not very serious and says just as long as my left vertebral artery is flowing blood properly then it should be of no problem.  The reason the MRA was issued was for my chronic headaches (going on one and a half years). Could this be the cause of my headaches? and if so, what would be the treatment for an occlusion? I have not seen a neurologist and and my PCP seems to be reluctant to refer me as he does not seem to think this is causing my headaches.  Please advise.....

-Dan Dinh
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Was the MRA performed with gadolinium or not? MRA is well-known to over-estimate stenosis. For example is your right vertebral artery patent and just congenitally small? However, complete absence of an artery is significant. It is true that as long as the left vertebral is patent, you may be asymptomatic. The concern though is, if indeed it is true, why do you have an absent right vertebral artery or severely stenosed. Also, is the basilar artery involved? You should have a thorough stroke workup and risk factor modification including blood sugar, blood pressure, lipids, and evaluation for antiplatelet. Lastly, headache associated with a “small artery” does raise the question of a dissected vessel. A dissection is a small tear in the blood vessels that travel up the neck to the brain. This can occur spontaneously in people with certain conditions that affect the blood vessels, after neck trauma, or after chiropractic manipulation of the neck. The pain is often but not always associated with some sort of neurologic deficit as a dissection can often lead to a stroke. A dissection is diagnosed with a specific type of MRI test (MRA with fat saturation) or a CT angiogram.

You should continue working with your physician regarding your symptoms. You may need to be evaluated by a neurologist. If you develop any neurological changes such as numbness or weakness, being evaluated urgently is recommended.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

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