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  • dustingfab
    Member
    Post count: 27

    Dear Dr. Corenman,

    In your professional experience, how many patients do you see with vertebral arterial stenosis due to cervical bone spurs or degenerative disc disease?

    I recently had two incidents of lip drooping. The first time it was just the left side. I had no other symptoms, except for a headache. But I always have a headache due to the herniated discs in my C-spine. In the ER, in the medical exam room, my pressure was high. I don’t have a hx of HTN. Bloodwork and MRI was normal. The doc believes I had a TIA. And referred me to a neurologists. I saw the neurologist a few days later. The PE was normal, pressure was normal. That same evening, I had a foggy headache and the lip drooping happened again but the right side of my lips only. No other symptoms. 2nd time in the ER, the doc believed I had an angioedema.

    The doc wanted to keep me to do the MRA in the AM. But wanted to go home. My neurologist agreed. I did the MRA today. I have the films, but no report. Of course, I don’t have the experience or trained eye to read whats normal or whats abnormal.

    Given the fact I have absolutely no co-morbidities, I believe this might have to with the fact I have DDD in my C-spine.

    Your thoughts. Thank you so much in advance.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8368

    The vertebral arteries supply the medulla, pons, cerebellum, thalamus and occipital cortex. The symptoms of vertebral artery insufficiency would affect these structures. These symptoms therefore include vertigo (imbalance), headaches, nausea and vomiting, problems with speech, visual disturbances and partial vision loss, sensory disturbances and even possible incontinence.

    The lip motor supply (obicularis oris) is from the facial nerve (cranial nerve seven) which is not part of this syndrome. As you note, headache can be from vertebral artery insufficiency but the vast majority of headaches are not related to this syndrome.

    I have looked for vertebral artery stenosis in patients for years. Patients that develop nausea and vertigo with neck twisting can have a dynamic problem as the twisting motion can cause temporary blood loss. I have had imaging studies performed for suspected vertebral artery insufficiency multiple times and have never found a patient with this condition.

    This syndrome does exist as there are cases found in the literature but no matter how diligent I have been to look for this, I have personally never found it outside of patients with a traumatic injury.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    dustingfab
    Member
    Post count: 27

    Dear Dr. Corenman,

    Thank you very much for your feedback. I got the MRA results back. I have right congenital vertebral artery hypoplasia (VAH). All vessels are patent and not sclerotic.

    Is there any possible connection to the VAH and cervical bone spurs. The exact impression of the recent C-spine MRI stated stable alignment, multilevel degenerative spondylosis. There is increase in size of left midline disc extrusion at C5-C6 resulting in left ventral cord impingement.

    The same day I visited the neurologist….On Tuesday (late) evening, I experienced the same symptoms again. Lip drooping. I had an excruciating headache early in the evening. But I always have a headache, so I didn’t think nothing of it. Then 9:30 came and went, 10:30 came and the right side of my upper and lower right lips were droopy. When I got to the ER, I was feeling pins and needles in my right cheek.

    The ER doc wanted to keep me overnight for observation and in order to perform the MRA first thing Wednesday morning. But I didn’t want to stay over. My neurologist agreed to let me go home. The ER felt that it might be an angioedema. But I wonder if it possible to have an angioedema so localized with no other associated symptoms of an allergic reaction.

    If there is absolute no correlation between the VAH and spondylosis then great. But despite my cervical and lumbar stenosis and disc herniations, I need to get healthy. Thankfully, my arteries are not atherosclerotic. But if that one vertebral artery gets any build up in the future I’m TOAST! I think, but of course I need to get medical advisement and guidance…cardio I suppose. Because this whole situation is way beyond my scope of knowledge. Or lack thereof.

    Thank you, thank you for everything…. reading and most definitely your feedback. I sincerely appreciate this.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8368

    Right congenital vertebral artery hypoplasia is somewhat typical. There is normally a dominant vertebral artery and normally it is the left. There is really no significant relationship between congenital hypoplasia and spur formation.

    Headache and lip drooping sounds more like a stroke set of symptoms. As one of your physicians stated- this could be TIAs or ?????? This is not my speciality. Angioedema could be a differential I imagine. You need a neurologist.

    It is unusual for atherosclerotic plaque to build up in the vertebral arteries.

    Hope you find some answers.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    dustingfab
    Member
    Post count: 27

    Thank you Dr. Corenman. I have to complete the blood work before I follow up. The results were already forwarded to my neurologist. So I assume this isn’t serious as I haven’t received a phone call to return to her office sooner than later.

    The spine specialist stated he didn’t see any significantly large bone spurs that would potentially impinge the vertebral artery. But I should make sure to follow up with a neurologist.

    Due to the recent C-spine, he is insisting on an ACDF. Which freaks me out. But I can only agree to this if it will decrease my risk of further TIAs/strokes.

    Thank you again for reading and providing your feedback.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8368

    In my opinion, an ACDF will not prevent your chance of a stroke which is very low to begin with. You apparently are already having TIAs and an ACDF will not change that occurrence. I cannot comment on the need for an ACDF as without a thorough history, physical examination and review of all images.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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