2nd opinion neuro - Subclavian Steal Syndrome

[wiggles94]

Had my follow up visit with my 2nd opinion neuro (first neuro said CIS - treat with REBIF).

This neuro is saying clinically possible MS - agrees with me staying on REBIF if I want to and will follow up in Feb with MRI on 3T scanner. My auditory and somatosensory evoked potentials are normal, as was mini-mental status exam he did.  

HOWEVER - after 2 hours of discussion, exam etc, my husband mentions that I have been having difficulty with any exercises that involve my arms - as far as feeling very light headed , weak , naseous.
SO he takes this seriously (all other docs just blew it off) and finds that that blood pressures between my left and right arm are different, and after questioning me about what happens when I work out with weights - says he wants me to have an MRA.

He thinks this could be subclavian steal syndrome - bascially when you exercise with your arms, blood to the brain gets diverted due to blockage in your subclavian artery - causing dizziness, etc.

He said it could cause ischemic strokes (I have 13 lesions in my brain) - and some of the symptoms I have been having.  HMMMMM>

Has anyone ever heard of this?
Carol

[wiggles94]

Thanks for the help everyone.  I will be SHOCKED if this is what it is, but since the MRA is noninvasive, why not take a look and make sure!  I'll keep you posted!
Carol

[Cosmobirdy]

I used to be an Ultrasound tech, and have actually seen Subclavian Steals numerous times over the years.  They aren't common, but I'd see a handful each year.  It can usually be easily diagnosed with a carotid ultrasound that also includes the vertebral arteries.  

With a Subclavian Steal, the blood pressures are usually different between the arms (but not always), with the arm with the Steal having the lower pressure.  This is due to the blockage restricting the blood flow.  The blockage itself is actually up in the collar bone area, just past the base of the neck.  The Subclavian Steal develops as the blockage becomes more and more significant, as the body's way to still supply the needed blood to the arm.

The carotid arteries are the main arteries running up the neck, feeding the face and brain.  The vertebral arteries are smaller than the carotids, and run more toward the back of the neck, but they also feed the brain.  With a Subclavian Steal, the blood in the vertebral artery instead runs AWAY from the brain, to help feed the subclavian artery, so the subclavian is "stealing" the blood from it's normal course.  The blood in the verterbral will sometimes run in a back and forth kind of way (called a "partial steal"), with the backward flow becoming dominant when the arm is exercised and requires more blood.

I won't bore you with any more of the details - I hope I didn't just confuse you with all this, lol.  If you want to know any more, feel free to PM me.  Subclavian Steals are actually very interesting when you come across them - and I'm always just fascinated by the ways our bodies instinctively try to fix problems that arise....  :-)

Rita

[COBOB]

They used to call it Aortic Arch Syndrome.  Wow.  I've only seen it in book and I worked at Bethesda.  I did have a guy with different BPs in his arms and his legs (IHSS).  Well, sounds like you'll be in someone's PowerPoint Deck

Sounds like you found a great doc!

[twitchychick]

Wow, I have never heard of that! Is it pretty rare?  I hope you get some answers, PDQ!

[Guitar_grrrl]

SSS - wow!  Interesting... A carotid ultrasound should reveal SSS as well, especially when the tech gets back to the vertebral arteries.  Keep us posted.