For many months now I have been suffering from daily attacks of transient neurological deficits and unilateral numbness.  In personal research, my symptoms strongly correlate to internal carotid dissection or cascading low flow TIA attacks (simultaneous foot, hand, face, neck, cheek, and tongue numbness, along with focal parietal and limbic neurological deficits).  

My neurologist immediately ruled out a vascular possibility since a general head MRI I had beforehand summarized as normal, and instead suspects epilepsy, cervicogenic headache, or atypical migraine.

However, in investigating the MRI images it seems like there might be an abnormality in the left petrous (horizontal) region of the internal carotid artery:  in one sequence the walls bulge on each side by about 20 percent, and the interior is grey rather than black in this bulge; in another there is a dark grey lining inside the artery seeming to almost obstruct it; and others show a thickened wall (whiter, in more slices) on the top of the artery; one sequence (T2 flair) shows a chewed-bubblegum like structure almost twice as large as the artery on top of it; and the sagittal sequence (T1) shows almost no black, with thick walls and almost another thick circle within the circle.  (All sequences except the sagittal were axial T2.)

I understand that arteries are naturally variable and hard to read on an MRI, and that I am by no means an expert and quite possibly have nothing to worry about, but it is possible there is something that was missed by the radiologist?

If so, how could I go about raising this issue with my neurologist, or try to quickly get a second opinion that will bring this to his attention?  My doctors are saying that further testing, such as MRA or angiogram, is unnecessary since the original MRI was normal, and since I am too young (<35), have normal cholesterol, and am neither asian nor black, so there is no reason to suspect vascular abnormality.

I want to be rid of this condition and get back to work as soon as possible, and would appreciate any advice.

Thank you.

Great question.

Obviously without looking at the images, I will give you my best guess.
Since you appear to be comfortable with terminology, I can tell you that petrous segments often have signal artifact in them.  The flow within the artery is turbulent in general with different velocities.  The petrous portion is horizontal and in the plane of imaging, rather than going in and out of the image (kind of like look on end of the tube).  so all those blood cells are doing different things on the axial plane in the petrous aspect. There are also almost 90 degree turns in the artery right before and after the petrous segement.  So, my guess is that all that is artifact.

MRI of the brain is ok to get an idea of the vessels but by no means it is as good as an MRA.  It appears that your doctors do not think that your syptoms reflect a dissection as a cause and I can't argue for or against it since I have very limited information.

Hope this is helpful.



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Michael K.


Almost any kind of questions regarding any types of radiology exams, procedures, meaning of radiology reports etc...


12 year experience in the field of radiology

American Society of Neuroradiology, Senior Member Society of Pediatric Radiology, Active Member

Radiology Seminars in pediatric neurology American Journal of Roentgenology American Journal of Neuroradiology

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