Hello and thank you in advance for taking the time to review my question and provide feedback - truly appreciate it.
I recently experienced a temporary loss of vision in my right eye. I have a history of Ocular migraines however this was different. I went through a complete cardiovascular workup including EKG, stress test, ultrasound, blood labs and Halter monitor. The ultrasound detected some turbulence in the right carotid and I was sent for a CTA with contrast. The CTA came back unremarkable, minus some sinus disease polyps. I was sent to a neurologist for further study.
The neurologist ordered an MRI & MRA w/o contrast. The MRI was unremarkable, however the MRA report suggested a slight outpouching of 1.3mm of the internal left carotid artery, cavernous region. The report suggested it may be a normal variance or possible small aneurysm - recommended follow up CTA. I recalled I had the CTA completed a week before and provided him the results. The radiologist reviewed the CTA and amended the report, “The slight outpouching along the posterior aspect of the left cavernous internal carotid artery corresponds to a very minimal undulating contour on the recent CTA neck. This is likely physiologic, with findings exaggerated on the MRA images due to the curvature of the vessel. In combination with the CTA images, there is no suspicious findings for aneurysm”.
At the same time the previous radiologist was updated on the INITIAL MRI/MRA report suggesting aneurysm and revised his report. “In retrospect there is a small 1 to 2 mm focal outpouching of the left internal carotid artery which could represent a tiny aneurysm but may also represent normal anatomic variant. Follow up MRA could be performed in one year”.
I spoke with this radiologist who was very focused on why he missed this in the initial CTA report. I assured him I wasn’t trying to place blame - just wanted it to not be true. He admitted that he showed this to a neurosurgeon and they both said they are “unsure” and “anyone would have missed this one”. I spoke with the neurosurgeon who essentially stated the same thing and called it “something” and “could be the start of an aneurysm”. He also told me “live a normal life and nothing will happen. If it were to burst its in a place that would not kill you”.
I am just really shocked and could use any advice provided on next steps. Reading about a possible diagnosis is scary enough but being shuffled around makes things worse.
Does this seem abnormal based on experiences?
Are there instances where “normal” anatomy for some people can resemble an aneurysm?
First of all, I would advice to try to calm down. In the worst scenario if there is a small aneurysm , it’s very small , nothing should happen there in a year , in a year you can do new MRI or CTA and the situation will be clear . May be it’s just your anatomy and artery goes such way .
In my case aneurysm is small 3-4 mm, it was accidentally detected overseas during MRI , by radiologist . When I came here to neutosurgeon , he was not sure at all that it’s aneurysm . They scheduled Angiogram . During this procedure the picture was clear and he confirmed the aneurysm , and there was another spot where another aneurysm possibly will be developed ( forgot its Termin .
So they probably don’t see the reason to schedule an Angiogram ( it would show complete picture ) yet .
However vision loss is serious , check it with ophthalmologist may be . But if you getting nervous or feeling worse , double check with your doctor if there is possibility to do an angiogram .
Also, keep in mind that MRIs are basically hyper-sensitive today, picking up things of no accord and making them seem important. It could very well be that the thing they’re talking about on you scan would have not even been “caught” by the last generation of MRI machines. Everyone has abnormalities, not all of them are of note. It could even be, as gk79 noted, that it’s completely normal for you!
It sounds like you’ve had two solid opinions from two professionals that are in agreement. You could always seek a third for your peace of mind.
Would it be reasonable to assume it’s physicologic and “normal” for my anataomy since the initial radiologist who interrupted the outpouching revised his report and traced his findings back to curvature found on the recent CTA?
My neurologist felt the CTA radiologist and hospital was trying to “cover their butt” since they may have missed something the first time. I did speak with the radiologist who was adamant that missing this was not his fault. I also spoke to a interventionist radiologist at this hospital who showed me the small area in question on the MRA but wouldn’t comment either way.
Limbo is the worst because I don’t want to do anything to possibly make this worse IF it is an aneurysm. I’m an active person that runs and lifts weights 6 days a week. If I had a diagnosis at least I could modify my life to play it safe.
Seenie from ModSupport here. Confused, it’s easy to see why you are confused and also why you are concerned. It also seems to me that none of the doctors see your condition as particularly worrying, because they’re all taking a laid back approach. Still, you have a legitimate question: can you inadvertently make this worse, and should you be modifying what you do to play it safe? That’s a question for your doctor(s). Please check with your PCP or one of the specialists you saw.
I have a consult with the original Radiologist on 10/8. I plan to ask him in detail about the updated opinion. If anyone has ideas of what to ask a radiologist I would welcome the feedback and advice.
If they did a survey of 1000 people with an aneurysm similar to mine, how many of those people would you expect to experience problems with it?
Is there anything that I can do, or avoid doing, to help keep this thing “quiet”?
If you had an aneurysm like mine, would you X, Y or Z? (x,y or z being the physically exerting things that you do)?
Here’s a strategy I have used with busy specialists: write your questions (and your concerns) out in advance. Make two copies. Give the doctor a copy to help guide the conversation, and you have yours. No doc has ever seemed to mind my doing that, and it prevents what happens as you get back into the car: Darn it I meant to ask about … With a list, I’m not saying it never happens, but it happens less to me.
I’m sure there are lots of other suggestions. Do you mind if change your post (or start a new thread for you) with a subject line that might produce a few more ideas for you?
I spoke with the radiologist today. He sugggested that there is NO aneurysm. He was very adamant that the MRA without contrast created an “artifact” or a pseudo-lesion — he defined this to be an illusion or shadow. He said the CTA with contrast was able to rule out any suspicion for aneurysm. He indicated the cavernous area of the internal carotid can sometimes produce results that are not accurate. He said there is no need for follow up or to chase this because he assured me there is nothing there.
I have an appointment scheduled with Cedars Sinai in Los Angeles. I now think going may be a waste of time for the doctor.
Does the information provided by the radiologist seem legitimate? I’m just asking for opinions and not medical advice. Thank you all again.
If there were aneurysm , the both tests MRI and CT should show it . From other side , from what I understood your doctor said , if it were an aneurysm it’s in a good spot , it would not couse hemorrhage bleeding if I understood that quote correctly.
May be investigate your loss of vision in unusual not standard way ( the standard scans are made already ) , have you checked this problem with ophtalmologist ?
I met with a neurosurgeon from Cedars Sinai today and he said I definitely have an aneurysm. I was shocked after speaking with the neuro radiologist yesterday who said I definitely do not have an aneurysm.
The radiologist suggested the MRA is exaggerated due to an artifact that resembles an aneurysm, but is actually a undulating contour of my vessel. He said he could verify this by tracing it back to a CTA with contrast and seeing the contouring vessel. He stated the CTA with contrast is the more accurate imaging because the cavernous region is surrounded by bone and veins.
The neurosurgeon however stated the MRA was more accurate and artifact was not possible. He said the cavernous region would not show well with the CTA and the MRA is better. His explanation was he “is the aneurysm expert” it’s what he does. He was kind of a jerk - laughed several times, didn’t introduce himself or a woman with him. His advice was not to smoke or do cocaine and again laughed before walking out of the room.
I’m really confused and not sure where to go from here. My gut wants to believe the neuro radiologist because he seemed to take the time and effort to rule out the aneurysm. Aside from being at a reputable hospital I have little faith in the opinion of the neurosurgeon at Cedars.