Can a CTA scan help with my syncope evaluation?

Question

Hello doctor,

I have been feeling weak, numb, and almost passing out randomly throughout the day for a month. I had a CTA in the ER, and they sent me home with this report. And they said to check with neurology, but not to worry. I have read it, and it says not to worry unless you are symptomatic, which I think I am. I have had a year of random anxiety, confusion, pain, and stroke-like episodes.

The neck CTA report read, no CTA evidence for internal carotid artery stenosis, occlusion, or dissection. Mildly hypoplastic right cervical vertebral artery without evidence for dissection, stenosis, or occlusion. Evidence for a prior right hemithyroidectomy.

The head CTA read, no CTA evidence for large vessel occlusion secondary to embolism or acute thrombus. Hypoplastic right intracranial vertebral and basilar arteries. Severe hypoplasia of the right posterior cerebral artery P1 segment with a patent right posterior communicating artery supplying blood to the right posterior circulation.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

You have hypoplastic right intracranial vertebral and basilar arteries and severe hypoplasia of the right posterior cerebral artery (attachment removed to protect the patient's identity). But with a patent right posterior communicating artery, which supplies blood to the right posterior circulation. In my opinion, this is the most likely cause of your dizziness and near syncope.

Before I explain that to you, I need to know if you have been diagnosed with any other medical illness or if you are taking any medications for any reason.

Do you have a family history of people having stroke-type symptoms at a young age, or do you suffer from migraine headaches (officially diagnosed)?

I hope this helps.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I would want you to see a neurosurgeon because you have vessels with low plasticity. This could be due to migraine headaches or the other way around. I am not sure if you have a neurologist or not, but this finding should be communicated to him.

Also, if you form clots and have a factor V mutation, along with this new information on board, I strongly feel you should be on a blood thinner. It seems like the posterior circulation still has a good supply through collateral circulation (at least that is what the report outlined), so a stent may not be needed.

Having said that, it would be at the surgeon's discretion and your decision.

I hope this helps.

Please let me know if you have any further questions and concerns.

Thank you.