Naked Science Forum
Life Sciences => Physiology & Medicine => Topic started by: Rebecca on 19/05/2004 01:34:43
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Good day everyone!
I recently had an MRA of the brain done because of some pain/spasms in the back of my head that have been going on for 2 years with no relief to various pain relievers. Have recently also had short term memory loss, slurred speech, mixing up my words, confusion. Doctor says I've had TIA's.
Findings from MRA of brain were: left and right posterior communicating arteries to the brain are congenitally small or absent. The intracranial arteries are tortuous. Both left and right vertebral and left and right posterior inferior cerebellar arteries are impinging on the medulla oblongata. Clinical symptoms may result from arterial impingement on the brainstem and lower cranial nerves and may be preciptated by trauma and/or other conditions. Otherwise unremarkable MRA of brain.
Is the impingement on the brainstem a problem????
What symptoms would you think a person with this problem be experiencing?
From the MRA report, would any of that cause concern?
Is it serious? [V]
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Posterior comm. arteries are arteries which make anastomosies between two other important arteries, and all are part of the "circle of Willis". But this isn`t uncommon to see, and probably isn`t the cause of your disease.
Chris, what exactly means impinging? Like to attack, penetrate ???
Well, anyway these arteries are found to be somewhat abnormal and to be the cause of deasease. The lower cranial nerves inervate musculles of the neck. Thay also give some sensory input to the CNS.
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Wish you better Rebecca.
'Men are the same as women...just inside out !' (https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Finstagiber.net%2Fsmiliesdotcom%2Fcwm%2Fcwm%2Frcain.gif&hash=32ae7f4f03d740b017b01cda28addd79)
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Rokitansky,
Thank you for the information. Most helpful. what does "lower cranial nerves inervate musculles of the neck" mean?
I'm concerned because I've had two Transient Ischemic Attacks and now some cognitive loss of functioning, i.e., immediate short term memory loss, slurred speech, mixing up my words, etc..
Thank you :)
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To inervate means that these muscles (sorry for spelling mistake), i.e. their contractions, are controled by impulses originating from these nerves.
My best guess is that ischemic attacks may come as a consequence of insufficient vascularisation due to disorders in atanomy of your cranial arteries.
Also wait too see what Chris and others are going to say.
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Neilip,
Hey, thank you - I appreciate that. :)
Rebecca
quote:
Originally posted by neilep
Wish you better Rebecca.
'Men are the same as women...just inside out !' (https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Finstagiber.net%2Fsmiliesdotcom%2Fcwm%2Fcwm%2Frcain.gif&hash=32ae7f4f03d740b017b01cda28addd79)
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You're welcome Rebecca...how are you feeling now ?...and what's the prognosis after your MRA ?..or is too soon to say yet ?
'Men are the same as women...just inside out !' (https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Finstagiber.net%2Fsmiliesdotcom%2Fcwm%2Fcwm%2Frcain.gif&hash=32ae7f4f03d740b017b01cda28addd79)
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Hey Neilep,
Well, I guess you could say I'm "twisted" - ha ha -- since the MRA said two arteries were "tortuous". Seriously, one neuro here in Florida says I've had two TIA's ..... but he didn't explain the MRA to me. These American docs.....
quote:
Originally posted by neilep
You're welcome Rebecca...how are you feeling now ?...and what's the prognosis after your MRA ?..or is too soon to say yet ?
'Men are the same as women...just inside out !' (https://www.thenakedscientists.com/forum/proxy.php?request=http%3A%2F%2Finstagiber.net%2Fsmiliesdotcom%2Fcwm%2Fcwm%2Frcain.gif&hash=32ae7f4f03d740b017b01cda28addd79)
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Rebecca, don't let a doctor blow past something that's important to you without stopping him/her to ask for an explanation.
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Rokitansky, thank you for responding. I'm curious to see what Chris and the others are going to say, but haven't heard from them yet.
I'll keep checking back. Thanks!!
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Sorry I haven`t been more helpfull. I don`t know what keeps them ?
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The report is a little confusing to me in the way that it's worded. Generally, and impingement of ciruculation will cuase the symptoms you describe. How an artery can impinge on the brainstem or nerves is confusing to me. An artery being impinged upon by structures in the brain makes more sense to me. Arteries are generally flexible and don't impinge on other structures.
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Bezoar,
Hmmm...you know, you're right. Makes me think of a piece of string and a rock. How can string impinge on a heavy object like a rock? Do I have it right?
I think I'll call the radiologist/doctor who interpreted the MRA and ask him for more clarification. Thank you for the input !!!
quote:
Originally posted by bezoar
The report is a little confusing to me in the way that it's worded. Generally, and impingement of ciruculation will cuase the symptoms you describe. How an artery can impinge on the brainstem or nerves is confusing to me. An artery being impinged upon by structures in the brain makes more sense to me. Arteries are generally flexible and don't impinge on other structures.
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"Findings from MRA of brain were: left and right posterior communicating arteries to the brain are congenitally small or absent. The intracranial arteries are tortuous. Both left and right vertebral and left and right posterior inferior cerebellar arteries are impinging on the medulla oblongata. Clinical symptoms may result from arterial impingement on the brainstem and lower cranial nerves and may be preciptated by trauma and/or other conditions. Otherwise unremarkable MRA of brain."
MRA means magnetic resonance arteriography (see Bob Bury's article about MRI / MRA for more information on the nuts and bolts of how the technique works and is used -http://www.thenakedscientists.com/HTML/articles/article/bobburycolumn7.htm)
MRA can be used to trace the path, distribution and patency of arteries, but without the risks associated with puncturing arteries, injecting contrast media, or exposing patients to X-rays (see : http://www.thenakedscientists.com/HTML/articles/article/bobburycolumn3.htm), which was the traditional way to map the vascular supply to a tissue.
The report states that the posterior communicating arteries are small or absent. These arteries unite the anterior (from the carotid arteries) and posterior circulation (from the vertebral arteries) by completing the Circle of Willis. Blood vessel layout is very variable between individuals and these vessels are absent in some people. See this former discussion on the topic, together with the vascular diagram contained therein in one of my prior posts http://www.thenakedscientists.com/forum/topic.asp?TOPIC_ID=700 to help clarify the anatomical layout.
The next tract of the report states that the intracranial arteries are tortuous. This merely means 'twisty' and can be a sign of age.
'Impinging on the medulla oblongata' - the medulla forms the base of the brainstem and the interface between the brainstem and the spinal cord. The vertebral arteries wind around the sides of the medulla and unite at its front to form the basilar artery. The posterior inferior cerebellar arteries leave the vertebral arteries and pass laterally (to the sides of the medulla) to supply the underside of the cerebellum. By 'impinging' on the medulla, the radiologist is suggesting that the arteries are pressing on the medulla on their way past.
It is difficult to comment on the clinical consequences of this radiological observation (indeed, there may be none) which is why the radiologist has covered his bases by adding "Clinical symptoms may result from arterial impingement on the brainstem and lower cranial nerves and may be preciptated by trauma and/or other conditions". In other words, the observed structural problem may, or may not, cause neurological sequelae.
It is certainly possible that some of your speech problems may be related to these findings because the motor nuclei supplying the tongue and face are located within this region of the brainstem. However, there are many other nerve centres within this region and one would anticipate that they too would be affected if this were the case. You do say that you have had TIA's before and that seems like a good starting point to launch investigations which should also include ultrasound dopplers of the neck arteries, and a check on heart rhythm.
Karen Smith's article about stroke provides some additional background information about diagnosis and management of cerebrovascular disease :
http://www.thenakedscientists.com/HTML/articles/article/karensmithcolumn4.htm
Chris
"I never forget a face, but in your case I'll make an exception"
- Groucho Marx