CTA showing double lumen

This image taken from my CT Angiogram shows two channels of the left vertebral artery.  In the medical world it is very rare for a doctor to come across this finding. The red arrow points to the left vertebral artery where two bump like images with a separation line between them is seen.  It is known as a double barrel lumen, double lumen or false lumen.  If you compare to the opposite side which is actually the right vertebral you can see this artery is patent and normal with no separation of the artery.

Whirring Wanderer

July 2015 Update

I am getting no where fast.  I am entirely exhausted by the battle in trying to obtain a diagnosis, I want to be headache free, noise in my head free, have no pressure in my head and neck when I stand.  Just today standing in the supermarket, my eyes filled up, I couldn't stop them and inside I was crying and thinking when is this ever going to end.  Why was I standing in a supermarket queue feeling exhausted when all I had done was walk there to collect a few pieces for dinner?  My body is struggling with the constant headache and noises in my head.  I want to be able to carry out a full shop of being able to go round the supermarket with a trolley and get everything I need without my headache becoming intense and the pulsing noise becoming louder not forgetting the relentless pressure in my neck and ear.


Unfortunately I am still being messed around with their lame mistakes.  I honestly don't think Dr Tyagi knows who I am or has read sufficient notes on my case.  On the 25th June 2015 I received yet another letter regarding having an MRI scan this time the appointment had been arranged for four days from the date of the letter.  I wondered if my CTA had been reviewed and they had seen the abnormality within my vertebral artery.  I emailed Dr T explaining I was yet again confused as earlier in June I had received similar to arrange a new scan.  Dr T responded by saying his recollection from our May appointment was that I had requested a further MRA scan to question dissection.  I honestly could not believe what I was reading in his email and he obviously has no recollection of the previous emails between us earlier in June when I received the previous letter regarding a scan.  I responded and told him the whole situation was becoming ridiculous and that I would be seeking advice to make a complaint.


I received a copy of the CTA scan that was carried out in March and I managed to view it on the 16th July.  I can see the abnormality on the CTA of the vertebral artery at V3 level/atlas loop.  I can see evidence of a dissection due to the double lumen showing, it does not look like a fenestration.  Now what concerns me is that I asked Dr T at May's appointment if my vertebral artery showed the double lumen as it was showing on my Mra and he said no.  I then asked him if it showed a natural fenestration of the artery and he said no it was patent and normal.  I managed to read the report on the disc (bearing in mind I never received a letter or report about my CTA)  The report reads:


>[Report Summary]


<BR>Clinical History :


<BR>? Left carotid dissection on MR angiography.


<BR>[CT Angio aortic arch and carotid Both]


<BR>CT Angio aortic arch and carotid Both :


<BR>CT angiography obtained from aortic arch to vertex


<BR>Normal appearances of the aortic arch and the origins of the


<BR>great vessels.


<BR>Normal appearances of the common carotid and both internal


<BR>carotid arteries from origin to termination.


<BR>Intracranial circulation appears unremarkable.


<BR>Vertebro-basilar system is patent. The basilar artery and


<BR>its branches are normal.


<BR>Imaged soft tissues and bones are within normal limits.


<BR>Imaged lung parenchyma appears unremarkable.


<BR>Conclusion: Normal appearances of the neck vessels.


If you managed to grasp any of it you will have noticed Dr Tyagi my Neurologist has questioned a CAROTID ARTERY DISSECTION and not the VERTEBRAL ARTERY DISSECTION.  The Carotid has been looked at and reported on, nothing mentioned about the left vertebral.  Not that it matters as the double lumen can still be seen on the scan, even for me who has no medical training its not hard to notice it.  I am at a complete loss at the amount of times doctors have failed to listen to me.  There is no excuse, I have given them the report from Dr Shapiro in New York and it states Vertebral, the emails that have gone backwards and forwards between Dr T and myself all state Vertebral.  At my appointment in May all the talk was about how my Vertebral was normal.


I decided not to email Dr T but instead start the complaint process by visiting Citizens Advice on the 21st July.  I can't keep giving these doctors any more chances, they are putting me at risk, I have two children to care for who need me.  I could be at risk of having another dissection in any of my arteries because no one has investigated to say otherwise. What if I didn't know any better and done some overhead painting again, there is nothing to say it won't happen again and my research shows it does frequently happen specially if people have any sort of connective tissue disorders.


Today, 24th July I received a letter from hospital to state my drug infusion has been brought forward to the end of August which is better than November.  I am very unsure about this drug considering it constricts the blood vessels and I am very apprehensive about going into hospital where it is clear that sub standard practices take place.  None of the imbeciles I have dealt with can read a scan properly.


All for now
Your still Whooshing & Whirring Friend

June 2015 Update

I have nothing positive to update as yet.  I received my appointment through for the drug infusion for November 2015, it also states MRI scan & Review.  It looks like they are planning to do a scan whilst I am in hospital in November. I find it entirely unacceptable I have been begging for help since November 2012 and now I need to wait over three years for treatment.


On Wednesday 3rd June I received a letter from a hospital in Glasgow called New Victoria Hospital stating they could not contact me by telephone to arrange my MRA and could I telephone them within one week or my appointment for the scan would be cancelled.  I thought it strange as Dr Tyagi did say at my previous appointment that one of the three options was that he could arrange for all my scans to be repeated but he would see no need, I had chosen option one which was the drug infusion.  Now I was thinking Dr T was on my side and he had gone out his way to arrange another scan.  I telephoned the New Victoria Hospital over the following days and never got a response it was a constant answer phone, I left two voice mails with my telephone number, CHI number & date of birth.  To be honest I was totally confused as I did not have any missed calls on any of my telephones from the standard 0800 6783393 Nhs number.  I have given my telephone numbers to numerous medical staff who have asked for it over the last 2 and a half years so this baffled me.  On the third day after not receiving a response from New Victoria Hosp I emailed Dr Tyagi to let him know I had received such letter and that I was confused.  I also reminded him I had requested a copy of my CTA on three previous occasions and had yet to receive it.  His response was "I am confused as well because I received an email from the neuro-radiologists questioning why I was asking for an MRI scan when a CT angiogram had been normal (I have written to you in this regard). Let me make enquiries and I will revert to you"  


It gets more confusing, later that day the post arrived and I did indeed have a letter from Dr T stating that my request for MRA had been refused due to having a normal CTA.  I never requested an MRA in the first place and does Dr T actually know what he is doing, he is the only one who is able to request scans.  I still had no answer to what had gone wrong with the letters and his promised "let me make enquiries and revert to you" has never happened.  He never does what he states he will do.  Yesterday on the 22nd June I sent another email stating I wish to make a subject access request and this was now my 5th time requesting a copy of my CTA scan that was carried out on the 19th March and had been requested on five occasions since 8th April.  Dr T responded "I have requested for the CT angiogram images on a cd again this afternoon."  Now this is the first time he has ever acknowledged that he has requested my scan, in previous emails he said he would do it for me and then nothing or he would disregard it in the other emails and only answer part of my queries.  I also asked twice at my previous appointment with him on the 20th May if he could please get a copy of the CTA to me and he said he would.


I am getting closer to the end of a very long rope.  What do I have to do to get doctor's to listen to me. 


I HAVE A SOUND IN MY HEAD THAT SOUNDS LIKE A BABY'S ULTRASOUND, I HAVE A CONSTANT LEFT SIDED HEADACHE, I HAVE CONSTANT LEFT SIDE NECK AND EAR PRESSURE, I HAVE A BLUR IN MY LEFT EYE, I HAVE BALANCE ISSUES WHERE I GET PULLED TO THE LEFT SIDE, I AM EXHAUSTED BY LATE AFTERNOON, MY HEAD BECOMES EXTREMELY HEAVY, EVERYTHING I DO NEEDS TO BE DONE AT A SNAILS PACE.


Maybe I have severe psychological issues, maybe my mind is not as sound as I think it is, is my brain sending false signals, maybe I don't have a sound in my head, maybe I'm imagining it all?  And maybe Elvis Presley is still alive and maybe all doctors who are covering each others backsides need to take responsibility for their failings in treating me fairly!

My scan Images

https://www.dropbox.com/sh/1epbpz3vaev80av/AAB-Df_lFBuDy9ZuHoq_WrDIa?dl=0

Above is a link to view a few of my scan images that I can see an abnormality on the vertebral around V3 level at the atlas loop.  Two Interventional Radiologists from New York and India have reported on my scans.  Another doctor from Florida suggested a healed vertebral artery dissection where a haematoma has penetrated the three layers of the artery and created a double lumen of the artery which basically means the artery has two channels at a small part of the artery at the back of the atlas loop where blood flow is being pushed through both channels.  I now understand why I am hearing the turbulent rhythmic sound in my head, its due to the blood flow,  I can imagine if a hose had water pumping through it and the hose split into two channels and then met up again then the sound would be turbulent.

I believe my symptoms are real and of someone who has experienced a VAD. I can see the images are showing evidence of a VAD.  The NHS (National Health Service) do not agree and state my MRA scan is normal.  My Neurologist Dr Tyagi stated to me and Mr Wanderer that the scan has picked up something that is not there and that the scan is normal.  I have unfortunately lost trust in all of these doctor's who have constantly closed doors and not allowed proper investigations to take place when I first presented.  My MRA was arranged by myself two years after my symptoms started as my GP would not refer me to Neurology.

While I have researched constantly on my symptoms I won't stop until I have definite answers.  I speak with so many sufferers who are experiencing pulsatile tinnitus and many do indeed receive a diagnosis.  It takes an astute doctor to question what their patient is presenting with, unfortunately for the rest of us our doctor's put us into the tinnitus bracket even though we explain a baby ultrasound rhythmic sound in time with the pulse.  There are many doctors who will also agree that their patient is suffering from pulsatile tinnitus and believe it needs no medical work up as they assume it is normal tinnitus which simply pulses.  This is a myth and after searching through hundreds of medical reports of which I would say 80% were all blood flow restrictions within the head and the other 20% were tumors.  I came across an extensive list of possible causes of pulsatile tinnitus.  A few of which were Carotid Dissection, Vertebral Dissection, Aneurysm in the arteries and veins, Dural Arteriovenous Fistula, Stenosis of the sigmoid and transverse sinuses (veins leading to the jugular) Ateriovenous Malformation, Temporal bone defects, Superior Canal Dehiscence & High riding jugular bulb.  The most important thing to remember is most of these causes can be diagnosed and can be treated.  Doctor's need to realise that any small stenosis either in the veins or arteries carries a risk of stroke.  I would immediately think that doctor's would want to investigate pulsatile tinnitus symptoms when any of their patients present with it.

It leads me to question how much training are GP's in the UK given on tinnitus and pulsatile tinnitus?  Surely with advancing medicine refresher courses and on going training would cover pulsatile tinnitus.  And finally PULSATILE TINNITUS IS NOT TINNITUS  My acronym suits this condition perfectly which is RATS.  Rhythmic Arteriovenous Tinnitus Sounds!  When a patient presents with RATS a GP should ask the patient to take their pulse with three fingers on their wrist and see if the sound in their head matches what they feel on their wrist, another option is to ask the patient to tap out the rhythm with a finger on the desk.

All for now Whirring Wanderer

May 2015 Update

Wednesday 6th May  I called my GP surgery to see if they had heard from my Neurologist as I had yet to receive a letter about my results of the CT Angiogram that I was promised.  The receptionist confirmed that they had indeed received a report from Dr Tyagi on the 16th April and that it was noted I had been sent a copy of the report.  I explained that I had received nothing.  The receptionist suggested that I call the hospital.  I decided to email Dr T again to remind him I had still not received the promised report/letter or a hard copy of the CTA that had been promised nor a follow up appointment. I explained how I was still suffering and no one was helping me and I reminded him that I'd been doing all the chasing and investigating my symptoms from January to May. He responded by asking that I go to the hospital the next day on the 7th May.  I called my husband Mr Wanderer but he was unable to get time off work at such short notice.  Dr T responded and asked that I visit the hospital on the 20th May at 1.30pm and copied his secretary into the email.  I spoke to Mr Wanderer again and he said he could take a holiday from work that day. 


On the day I felt a bit apprehensive, I had this strange feeling that something wasn't right and wouldn't go to plan but I kept telling myself I was being silly. 


We arrived five minutes early to find the reception, when I spoke to check in the reception chap said I was already checked in. The receptionist was slightly puzzled and repeated my name back to me and  an address in Hawick.  I immediately said that was not my address and asked was there a possibly of two people with the same name.  The receptionist still puzzled, asked me to confirm my date of birth and address to which he replied the other lady was almost twenty years older.  I asked had we both been booked in for 1.30pm to which there was a hesitation and then a yes, we were both there for one appointment.  I showed the email from Dr Tyagi and his receptionist confirming my appointment. We had a seat in the main reception, then the receptionist appeared and said there was a lady sitting in the waiting room for an appointment that was not needed.  We were then taken to a waiting room.  I looked around to see if I could see the "other me twenty years older"  As the time was going on I realised that the other lady was obviously in seeing Dr T.  Eventually she emerged and I heard reception chatting to her and apologising.


When I was called for by the nurse for my appointment it had gone 2pm.  Dr Tyagi started off by explaining the error and that he was partly to blame and so was his secretary and that the other lady had been sent a letter for todays appointment.  Dr T then carried on with the appointment and asked me to explain my symptoms, he went into my file on the computer then quickly closed it again saying  "I will get that sorted" Mr Wanderer and I seen the other ladies letter in my file which was obviously the letter that was meant for me.  I was slightly annoyed that I had to explain my symptoms again as I had given them on every occasion I'd seen him and I had also typed them up and given a paper copy to him, anyway at least he would maybe remember this time.  I still had an underlying feeling he doesn't really remember me or my case.  I decided not to be a difficult patient and proceeded to list all my symptoms again which he typed into his computer.  Dr T then began to explain had I hypothetically had a dissection what the treatment would have been and that it would of entailed six months of anticoagulants or aspirin.  I questioned everything he stated and said that hypothetically had I of had a dissection that healed without causing a false lumen then that might of been the case yet here I was clearly suffering on going symptoms of dissection because of the false lumen pressing on adjacent structures causing nerve damage.  I continued and questioned the scans because I had reports from other doctors around the world that said my Mra was abnormal and how did that compare to my CTA.  Dr T confirmed that my MRA & CTA were normal and were marked normal. I was getting annoyed and upset at this point because as I explained to him I could see that the artery is not normal and I have over 200 scan images showing same.  Dr T decided that an Mra can pick things up and highlight them when there is actually nothing there, he mentioned fat saturation on the scan but I had to remind him that that technique was not actually used on my scans.  Therefor what he was stating didn't apply.  I mentioned about the MRA being marked normal and how was it possible that I had reports from other doctor's on my Mra that state they can see evidence of a vertebral artery dissection. I asked did the CTA show a false lumen or a double channel in my artery and he replied the lumen was normal and patent.  I asked how this was possible and he replied that "an Mra can have movement and show a high signal" but then he back tracked and said "not that there was any movement in your scan".  I reminded him that I still had no letter of my result and that I had emailed him on more than one occasion asking for it as well as a copy on disc of the CTA, he said he would get a copy of the CTA for me. He absolutely refuted that I had a dissection and had it been one they would not operate to get rid of the false lumen as I had mentioned that the doctor in New York had suggested how to fix the artery in his report.  I asked again that I wanted a copy of my CTA scan and report to get an opinion on it, again he said it was not a problem, that I was entitled to do so.  When I got upset Mr Wanderer spoke and gave his opinion it was only then that Dr T offered three options after saying what did I want them to do.  I was blunt and said I wanted a diagnosis and wanted to be treated to stop the symptoms, I said surely after suffering over two and a half years I was entitled to find out what was causing all these problems, he sat nodding saying "sure, sure"  He then offered a drug infusion to try and take the headache away, which I agreed immediately to. I am now awaiting that appointment to go into hospital and have it done, the other option was to repeat the scans yet he said there was little point in doing so. The last option was an Occipital nerve block injection which I reminded him that he had already sent me for last November that didn't work.  I feel he only offered up the options because he felt he needed to be seen as doing something because I was upset.  Why could the drug infusion not have been offered last year? 






Thanks for reading the never ending VertebralGate
Whirring Wanderer

April 2015 Update

Unfortunately I am no further forward. I called my doctor's surgery on the 26th Feb and explained no one has been in touch.  The practice manager called me back that afternoon and said they had chased the Neurologist.  Dr Tyagi eventually called me on the 27th February to say the Neuroradiologist Dr Rod Gibson from the private hospital reviewed my scan and read Dr Shapiro's report and stated he understood the points raised but there was no definite evidence of vascular dissection and his view is unchanged and the MRA is normal.  I was really upset by Dr Gibson's statement.  I can see the MRA is not normal, you can clearly see the split through the artery it has created a double barrel lumen.  Two weeks later I received the above statement in writing, strangely Dr Gibson seems to contradict himself by stating the vertebral artery is VERY tortuous at the point where Dr Shapiro discusses the possibility of the abnormality being a dissection or natural fenestration, however why does Dr Gibson not state this in his original report that the artery is very tortuous instead he stated the scan was normal and could find no findings to account for the pulsating sound in my head and my headaches.




Dr Tyagi agreed to a CTA which was carried out on Thurs 19th March.  After 3 weeks I hadn't received my results and emailed him on the 8th April, I got a reply stating simply "I can confirm your CTA was normal, I will arrange a follow up appointment"   It seems the report from Dr Shapiro did not exist and was being dismissed.  Dr Tyagi also mentioned in his email I would get a copy of the report soon that was being sent by post.  I sent a response back asking why I was so symptomatic if everything was normal, I also asked that while sending the report if he could include a copy on disc of the CTA.  He responded back to me on the 14th April and said he would have it arranged to have a copy on disc and that he was sorry I was still having symptoms and would arrange a clinical review.






I have since found another assistant professor who is a Neurointerventialist in India and who has written a medical report on a patient with the same type of dissection as Dr Shapiro reported on mine.  I tracked the doctor down to a hospital and emailed my symptoms and a few scan pictures not thinking I would get a response. The doctor responded with marking my images where the dissection was and stated my symptoms are due to the nerve damage of surrounding tissues structures being compressed due to the artery being larger caused by the false lumen and that some of my symptoms for example my balance being off is due to reduced blood flow because of the two channels being created by the dissection.  This doctor has dealt with patients who have experienced symptoms the same as mine.  Eventually I was getting some sort of acknowledgement for my suffering be it from the other side of the world in India.  The doctor asked that I send all my images which I have done and I now await a further reply.  Hopefully once I have this doctor's report doctors here in Scotland will believe me and offer to help me of these debilitating symptoms.






Thank you for reading my pathetic but desperate posts.
Whirring Wanderer

Febuary 2015

THURSDAY 5TH FEBRUARY

I contacted my GP surgery to see if Neurology had been in touch and I was asked to call the local hospital appointment department where I was told to give it until Monday and call back.  I said it was an urgent referral and it was explained that the referral had not yet been vetted. It had been referred back to Dr Tyagi the neurologist who I had seen recently in December  I then called the GP surgery back and explained what I had been told by the hospital,  Dr Stevenson was in a meeting so I asked the reception to note that I was frustrated with the lack of speed that it was being dealt with considering it was an urgent referral. I emailed Dr Tyagi myself with a copy of the report from New York.





MONDAY 9TH FEBRUARY

Dr Tyagi emailed to say he had a copy of my scan and with the report I sent from Dr Shapiro in New York he was planning on speaking to the neuroradiologist from the private hospital at Ross Hall that  week and then he would be in touch for further management.





WEDNESDAY 18TH FEBRUARY

I have not had a response from any medical profession and still await what the further management is.  I wonder what the protocol would be if I had presented with a VAD that had actually been recognised and diagnosed straight away, would I be given medication and sent immediately for an angiogram and given something to take away the extreme headache?


Whirring Wanderer