Hi all,

I'm Alisa, I'm 18 and I had surgery December '04. And about 6-7 weeks ago I had a TIA/"seizure-like activity" somethingerother. My mom and I were walking into the gym we work out at, and I was trying to describe my trip I had taken to the zoo that past weekend while she had been away. My speech was definitely incoherent, and I was definitely feeling the old moyamoya symptoms coming on as we were walking through the entrance. Long story short, I fell down. The whole spell of the numbness, tremors, dizziness lasted about five minutes.

When we got home we called the neuro- surgeon/ologist immediately. And they immediately said seizure. However, I had an EEG and blood work the next day; but the EEG came back clear of any seizure activity.

The neurologist upped my anti-seizure meds from 1000 mg of Keppra/day, to taking an extra 125mg pill at bedtime. But during the first week I was up all night (for several nights), extremely dizzy and nauseous. However, a few weeks later, when I was up at school, I woke up feeling the same way. (Also, at that point we were making weekly phone updates to the neurologist). The neurologist said that he thought I could safely be taken off the extra pill at bedtime, if it's making me feel so terrible. This was about 4 weeks ago, and I haven't had any problems with dizziness or nausea since.

So my questions are:

What makes moyamoya symptoms different from TIAs? Because I have had legs fail me many times prior to surgery, but I had a considerable bruise on my butt after the tumble in August.

Wouldn't taking me off the higher dose of the anti-seizure meds indicate to the neurologist (and me) that even he's questioning if it was a seizure?

I am now home from college for the semester, and thinking about commuting somewhere closer to home (or going back to my old school) in January. But as the doctors are still declaring seizure, it is Michigan law that you be seizure free for 6-months before you can drive again. Plus I will need to get a job ASAP...

Any advice or opinions would be a great help. Thanks!

Hi Alisa,

Wow, your recent incident at the gym sure sounds frightening. :-[ I'm glad, for the most part, it wasn't something very serious; although, I do believe that our bodies give us warnings that we need to take heed to.  I know you had an EEG which was normal, but I recently read in another post that someone else had a normal EEG, but she did experience a seizure or seizure like activities.  I would ask about any other types of tests that can be done to see exactly what it was that you experienced...and then, (I know I sound like broken record), I would send them to MM specialists for their opinions.

Hmmm..I'm just wondering, does raising anti-seizure medications for brief periods of time help prevent seizures?  I would think that one would have to stay on the increased appropriate dose to prevent further seizures.  I'm thinking, if he discontinues the extra 125 mg of Keppra, then you'll be back on your regular dose right?  Would that make you at risk of having another episode?  I'm not too familiar with seizures, but I'm sure many here are...let's see what others have to say.. ;)

In the meantime, I would ask your doctor if there's any other test other than the EEG to find out exactly what it was that you had, and also a good reason to follow-up on your surgery.  Have you had an angiogram or any other follow-up tests since your surgery in 04?
[smiley=twocents.gif]
Take care,
Shan

Hi Alisa Marie  

Welcome to this website.  I see that you are from Michigan.  Where did you have your surgeries?

Janice

Alisa Marie wrote on Sep 29^th, 2005 at 1:16am:

What makes moyamoya symptoms different from TIAs?

I really think it depends on the person. My MM symptoms were only TIA's.

Are you remaining hydrated through your work outs?
Just a thought....

-Shari

I have had quite a few seizures, with only a few being very serious ones.  I have recently had an EEG done, but I am still waiting for the results.  The first EEG that I had done did not show any seizure-like activity.  This was b/c I did not have any seizure-like brain activity during the test.  This is the problem with EEG testing and why the try to stimulate your brain so much during the test.  (Sorry if you know all this already)

Anyway, my point it that EEG are not always a definitive test in determining if an episode (or spell as I call mine) are seizures.  I recently had a bad spell, but I remained mostly conscious.  My hubby and I thought it must be a stroke or TIA.  When we arrived at the ER they said that b/c I had experienced such an incredible array of symptoms during my spell, I could not have had a TIA.  TIAs are apparently much more symptom specific..does that make sense?  TIAs that I have had in the past have manifested as problems speaking or trouble with my hand.  The trouble arises however with simple partial seizures.  These present with usually one symptom, or affecting one paret of the body.  My focal seizures, as they are also called, present in my hand.  My fingers twitches as if I am trying to squeeze something between my fingers and my palm.

I could go on and on, so I will stop.  My 2 cents are I would go up in my anti-seizure meds.  If the Keppra bothers you try another, there are sooo many.  You could even add on one with your Keppra.  I have heard great things about Lamical.  I always choose to go up on my meds, but that is me.  I am not one who despises taking medicine.  In the end you have to decide if your fear of having another epidode scares you enough to take more meds.  Also, if you want to ensure that you remain seizure-free so you can get your liscense back.  I understand that the episode may not have even been a seizure, but what if it was.  I also understand that you may never have another episode, but what if you do. Many people choose to gamble, it is your decision in the end.  I will stop by diatribe now. Just remember, you are not alone!  

Take care and let me know if I can help out in any other way,
shgerig@earthlink.net
Stephanie (SHGR)  

Hi Alisa,

I wanted to look up your question more, so to "Google" I went and found the following below.  I guess the answer to your first question, if I'm reading this right, is that TIAs could be a symptom of MM.  Before I was properly diagnosed, I was clueless of what a TIA was and didn't realize that the tingling and numbness in my hands and face were actually TIAs!  :-[  I read that you also mentioned your "legs failed you."  Did your legs become weak just at a moments notice with no warning?  [smiley=huh.gif] Hmmm.

Well, in my quest to help find answers to your question, I've come across the following sites that may help...
http://www.epilepsy.com/101/ep101_symptom.html
and
http://www.stanfordhospital.com/clinicsmedServices/COE/neuro/moyamoyaDisease/default

Moyamoya Symptoms:
As the vessels narrow the brain receives less blood.  This can result in temporary symptoms such as:

Headaches
Numbness or weakness in the extremities
Difficulty speaking
Stroke
Symptoms

Children typically have symptoms including:

Strokes (sustained weakness or numbness in an arm or leg, difficulty speaking, visual abnormalities or problems walking)
Transient ischemic attacks, or TIA’s (temporary stroke-like symptoms that don’t last long)
Headaches

Progressive cognitive or learning impairments
Children also often experience temporary weakness in one or more of their extremities during strenuous physical activity or when crying.  Adults can also present with brain hemorrhage causing neurologic symptoms in addition to nonhemorrhagic strokes, TIA’s and headaches.

Seizure Symptoms:
Black out
Confusion
Deafness/Sounds
Electric Shock Feeling
Loss of consciousness
Smell
Spacing out
Out of body experience
Visual loss or blurring
Fear/Panic
Chewing movements
Convulsion
Difficulty talking
Drooling
Eyelid fluttering
Eyes rolling up
Falling down
Foot stomping
Hand waving
Inability to move
Incontinence
Lip smacking
Making sounds
Shaking
Staring
Stiffening
Swallowing
Sweating
Teeth clenching/grinding
Tongue biting
Tremors
Twitching movements
Breathing difficulty
Heart racing

Just remember, this is all textbook information, and we may all have different symptoms from one another, as our individual situations differ.  However, I think it is good to know what the symptoms are. ;;D

I agree with Stephanie's way of thinking about taking meds.  Hey, "whatever works" is good for me. I'm all about preventive medicine, if possible.  By the way, I  [smiley=heart.gif] reading your posts, Steph, and hate when you say "I will stop."  ;)  I'm thinking in my mind...no, keep going!..continue!  ;;D

Hope this helps Alisa.  Take care,
Shan

janicetedd wrote on Sep 29^th, 2005 at 4:36am:

Hi Alisa Marie   Welcome to this website.  I see that you are from Michigan.  Where did you have your surgeries? Janice

I had my surgery at Beaumont Hospital in Royal Oak.

STrantas wrote on Sep 29^th, 2005 at 9:22am:

I really think it depends on the person. My MM symptoms were only TIA's. Are you remaining hydrated through your work outs? Just a thought.... -Shari

The whole episode was before I even started working out. So I don't think lack of hydration was an issue; because I drink at least two of those huge Nalgene bottles a day.

Shan wrote on Sep 29^th, 2005 at 1:46pm:

Hi Alisa, I wanted to look up your question more, so to "Google" I went and found the following below.  I guess the answer to your first question, if I'm reading this right, is that TIAs could be a symptom of MM.  Before I was properly diagnosed, I was clueless of what a TIA was and didn't realize that the tingling and numbness in my hands and face were actually TIAs!  :-[  I read that you also mentioned your "legs failed you."  Did your legs become weak just at a moments notice with no warning?  [smiley=huh.gif] Hmmm. Well, in my quest to help find answers to your question, I've come across the following sites that may help... http://www.epilepsy.com/101/ep101_symptom.html and http://www.stanfordhospital.com/clinicsmedServices/COE/neuro/moyamoyaDisease/default. ....... Just remember, this is all textbook information, and we may all have different symptoms from one another, as our individual situations differ.  However, I think it is good to know what the symptoms are. ;;D I agree with Stephanie's way of thinking about taking meds.  Hey, "whatever works" is good for me. I'm all about preventive medicine, if possible.  By the way, I  [smiley=heart.gif] reading your posts, Steph, and hate when you say "I will stop."  ;)  I'm thinking in my mind...no, keep going!..continue!  ;;D Hope this helps Alisa.  Take care, Shan

Thank you so much for doing all that research!

Before I was diagnosed with MM, my leg would go numb and go all floppy on me, so that I could not stand. The first of many times that happened, I did fall. But then i learned that I had to sit down whenever I felt like that again, otherwise I would fall.

What happened this last time, is that first the right side of my body was feeling TIA-ish, but then my whole body felt that way, and that's when I fell over. Because my whole body was like jello when it's all jiggly.

I had a conversation with a friend of ours whose son had epilepsy for about four years, and then just grew out of it. She said that the anti-seizure medication more-or-less gives your brain a chance to heal, and calm down. And you can still have seizures, no matter how much meds you are taking. My cousin was in a near fatal car accident about 8 years ago, and now in a semi-permanent vegetative state. She takes 3000 mg of Keppra a day, and she constantly has seizures.

And I don't particularly want to switch to a different anti-seizure med, because I don't have any symptoms on the 1000mg/day dose. Unlike dilantin, which completely trashed my body for 3 months.

You're very welcome Alisa. I myself am learning a lot while trying to help others.  Anyway, I'm thinking that the episode you recently had at the gym sounds a little like what you experienced prior to being diagnosed with MM and your sugery.  To be on the safe side, can your doctor offer you any tests to find out more about what exactly what it was that you experienced?  I know he increased your Keppra, but did he order any tests?  Have you had any follow-ups tests since your surgery (i.e. angiogram, MRI/MRA, etc?)  I don't want to scare you or anything...I'm just wondering.  Your incident frightens me too, and I'd rather be safe and look into what triggered it, that's all.  

Take care,
Shan

Alisa,
You do not need to feel like you need to switch meds, especially to such a hrad-to-deal-with drug like Dilantin.  I have a great friend who take a mix of Keppra and Lamictal (which also helps with headaches).  

I would look into what is called "drop seizures".  That is what your old seizures sound like.  But again they could also be TIAs.  However, I do think that TIAs are usually unilateral, one-sided; they would affect only one leg or the other, but not both.

Thank you for your very kind words, Shan. But, I love reading your posts.  Always so informative.

Take lots of care,
Stephanie

Thanks for all your advice Stephanie.

But as I am very blessed to not have a very extreme case of moyamoya, and did not have any headaches or symptoms immediately after surgery. The first sign I've had of a symptom is what happened to me in August. So if I can get by on as little medication as possible I would like to. Plus, I don't want to be messing around with meds when I am trying ever so hard to get back to college in January, because I could deal with a job and taking lots of different meds, but in college you need to be on top of your game and not be taking 4 hour naps in the middle of the day, every day

Alisa,
I definitely understand your desire to not take meds. I am not sure anyone really likes taking meds.  I also understand wanting to be as "yourself" and side effect-free.  I wish you luck with your return to college and I hope you will be episode-free.
Take care,
Stephanie  

Hi Alisa,

I'm curious about your experience with Dilantin, if you don't mind sharing.  I am slowly being weened off of it and am now down to 200 mg per day. (I was on 400 mg per day).  I am also taking Zonegran.

Alisa
Quote:

"Unlike dilantin, which completely trashed my body for 3 months."

Thanks,
Shan

Hi, Alisa.  Welcome to the group.  I am sorry about your experience at the gym.  It does sound like it could be either a TIA or seizure --- it can be very hard to tell the two apart!

It is true that an EEG can come back normal, even if you have had a seizure -- but a normal EEG does lower the likelihood that it was a seizure, so I think you are right in wondering if your neurologist is questioning whether it was a seizure, too.

Our neurologist also said we have to be careful with seizure meds with our daughter (who has MM disease, and a seizure disorder).  There are some, like Phenobarb, that are sedating, and could lower blood pressure.   Very frustrating and confusing  :-/

At any rate, I was wondering when you had your last follow-up surgery testing (angiogram, MRI and SPECT), and whether you had one side done, or both sides.  MM is progressive, so any new symptoms should be followed-up on closely.  Of course it could be a seizure, and MM patients are certainly prone to them, but it could also be a sign that something else is going on.

Jenny (mom to Daphne.  Two next Friday.  MM dx at 15 months, after suffering seizures since 3 months old, and strokes at time of diagnosis.  www.daphnestory.com)

Shan wrote on Sep 29^th, 2005 at 7:55pm:

Hi Alisa, I'm curious about your experience with Dilantin, if you don't mind sharing.  I am slowly being weened off of it and am now down to 200 mg per day. (I was on 400 mg per day).  I am also taking Zonegran. Alisa Thanks, Shan

Hey Shan,

I think I was taking 600 mg/day, although I can't be for sure, because my experience with Dilantin was so bad, that as soon as I switched meds I threw it all out.

While I was taking it I was extremely emotional, I would cry at anything and everything. I was depressed, very antisocial, and it makes all day nap time. I was so exhausted all the time, and I tried taking several naps a day, but often times I couldn't fall asleep. Also, I gained about 10 lbs.

I know everyone has different reactions to different meds though. People have some horrible side effects with Keppra, but I don't. Although my neurologist says that the surgeons like to use it, because it has reliable qualities, and it can be used in IVs. But he thinks some of the newer drugs have a lot to offer in the lesser-side-effect department.

If you have any more questions, feel free to shoot me a message or something.

kotipup wrote on Sep 29^th, 2005 at 8:07pm:

Hi, Alisa.  Welcome to the group.  I am sorry about your experience at the gym.  It does sound like it could be either a TIA or seizure --- it can be very hard to tell the two apart! It is true that an EEG can come back normal, even if you have had a seizure -- but a normal EEG does lower the likelihood that it was a seizure, so I think you are right in wondering if your neurologist is questioning whether it was a seizure, too. Our neurologist also said we have to be careful with seizure meds with our daughter (who has MM disease, and a seizure disorder).  There are some, like Phenobarb, that are sedating, and could lower blood pressure.   Very frustrating and confusing  :-/ At any rate, I was wondering when you had your last follow-up surgery testing (angiogram, MRI and SPECT), and whether you had one side done, or both sides.  MM is progressive, so any new symptoms should be followed-up on closely.  Of course it could be a seizure, and MM patients are certainly prone to them, but it could also be a sign that something else is going on. Jenny (mom to Daphne.  Two next Friday.  MM dx at 15 months, after suffering seizures since 3 months old, and strokes at time of diagnosis.  www.daphnestory.com)

I last saw my surgeon in June. And he said that unless I was definitely seeing more symptoms, other the the post-surgery ones, that I really didn't need to have any more tests done in the near future. He does feel that there is a good connection, and a good pulse from the vein. I did not have any headaches, dizziness, or TIAs immediately after my surgery. In fact, I spent one night in ICU on morphine, and after that I took tylenol because I was running a fever a day later.

I only had surgery on the left side. Because the angio showed that the right side had figured out a way around the blocked vessels, and was backwashing the blood through the right side of my brain.

And although angiograms are probably the most definite way to tell what's going on, I never want to experience another one for the rest of my life, unless it's absolutely necessary. It was the most terrible, painful experience that I have been subjected to in my entire life.

So to answer your initial question: no, I have not had any post-surgery tests done. But I probably should.

Hi Alisa,
Just a quick word to say that I really sympathise with what you are going through at the moment and to also say that I can relate to your dislike of angios. The first angio I had done was to diagnose my MM and it was singularly the most painful frightening thing I have ever experienced, but since my surgeries I have had others done and they are not so bad, not at all painful apart from the inconvenience of having to lie flat for most of the day. Just to reassure you that if you have to have another angio done, it probably won't be as bad as the first
Moira

Moyamoi,

Glad to read your last post.  I, like Alisa, only had 1 angio so far and that was right before my surgery..and it was an experience alright.  I remember it hurt when they told me to "hold your breath" and shot the dye in to take the pictures.  I saw flashing lights...kind of like fireworks going off.  Was your experience similar?  I know I'll have to have one at my 1 yr follow-up though, so it was encouraging to hear that they do get better.  Maybe at least this time, I'll know more of what to expect.  The only thing...it scares me because I was once told by my 2nd neuro that the risk is 1 in 1000 that I could have a stroke during the procedure.  And, having a disease that primarily affects 1 in 2 million...I didn't think the odds were on my side.  [smiley=twocents.gif]  Therefore, it frightens me.  

Jus wondering..Were you, or anybody else told of this same figure/odds?  [smiley=huh.gif]  I know it HAS to be done and there's no way around not having an angiogram, so I'm going to do it...BRING IT ON!  ;;D [smiley=biggrin.gif] [smiley=cry2.gif] [smiley=worried.gif] [smiley=frown.gif] [smiley=youknow.gif] [smiley=yikes.gif]

Alisa,
Maybe an MRI/MRA, SPECT, CTA or other test may be sufficient for now...just to see if there is any activity going on relating to MM.  However, I, like you, will one day have to have another angiogram.  I understand how reluctant you are about it, but we've made it this far, so let's not let one test stand in our way to a brighter future!  ;)  Together...somehow...we can overcome...  [smiley=hug.gif]  You just go first, okay?  ;;D  hee hee.  I'm just kidding... Seriously, there are many here that have and are going through the same tests/procedures as us, and are a living testimony that everything is in God's hands and will work out the way He wants them to...for the best!  

This is one of the greatest things about this site.  We can hear/learn about others who have gone before us to share with us their own personal experiences of what they went through and how they dealt with the situation (i.e. tests, surgery, etc) that we are about to embark on!  ;;D ;) ;) ;;D ;) ;;D ;) ;;D ;; Absolutely wonderful, DJ!

Take care,
Shan

Hi Shan,
just replying to your post - My original experience with an angiogram was horrific! When I had to hold my breath, it hurt - it was like an electric shock going off in my head with a major firework display! I also couldn't walk without pain for at least 3 weeks because of the pain in my femoral artery.
They told me the odds of having a stroke during the procedure was roughly 10% and to make matters worse, I was transferred to another hospital to have the procedure done for the day and my husband wanted to be with me when I came out of it as I was so scared, but they told him that I was not at the hospital, and when they found I was at this hospital they made him wait in a totally different section so he was unaware that they had taken me back to my original hospital and he was very upset that he was'nt there for me!!
But when I had another one done about a year later,
there were no flashing lights or pain when the dye was injected so that was a huge plus!! I also didn't have the pain in my legs. (I had this procedure done in a private day hospital but the first one was done in a public hospital, even though I was in a private hospital for the ops)
I was due to have another one about a year or so ago now, but I stalled it off by saying I couldn't leave Chad alone for the day (my 2 year old) and would wait when he was a bit older, but saw my neurosurgeon about 2 months ago and told him I was ready to go for the angio and he told me there was no need,as he only wanted me to have it so he could gloat at his work!! and I was well and truly "cured" and only to see him if I got any symptoms.
So amen to that!!!
Kind regards Moira

Shan and Alisa,
Just wanted to share my experience of my 3 angios.  I agree that the pain is not as bad the second and third time.  But I continued to experience the flashing lights and the pain for several days after the procedure.  I HATE this procedure and liken it to sticking my head into hell everytime they say "hold your breath"!  I can empathize with you all, as I am sure the rest of the members can, that this test is the pits.  
Good luck with any possible tests! :D
Stephanie

Stephanie,


Quote:

"liken it to sticking my head into hell "

[smiley=laugh.gif]  Sorry,  [smiley=oops.gif] I couldn't stop myself from ROFLMAO on that one!  

I'll remember your quote when it's time for me to have my second angio...to help "lighten things up"  and distract me ;;D

Thanks for the visual Steph!  ;;D
Shan

Shan,
Yippie! Glad to oblige!  
Lots of love,
Stephanie

Hi Alisa,


Quote:

I last saw my surgeon in June. And he said that unless I was definitely seeing more symptoms, other the the post-surgery ones, that I really didn't need to have any more tests done in the near future

It seems to be standard practice, especially by the surgeons considered experienced in MM, to order an angio between 3 months and 1 year post-op.  It's imperative to see if the graft is patent and/or (depending on the surgery) new blood vessels are forming.  In general to see if there is improved blood flow with no occlusions.  Since you are experiencing some symptoms I would suggest you insist on having some sort of test done whether it's an angio, SPECT or MRA.

I, like others, found the angio to be a lot less painful after my surgery.  I believe it's because before surgery your arteries are occluded hence it's like putting water into a balloon that is already filled near bursting.  After the surgery, when hopefully there are little or no occlusions, the solution just flows right through as it's supposed to.  I have had 3 regular angios and agree that 2 of them (before surgeries) were insanely painful!  Another tip I have, try to get a CT Angio!  I LOVE THOSE!  But, it is a fairly new concept and not all hospitals have the equipment to perform them.  This was just like having a CT scan- no laying around all day, no pain, no puncturing the artery etc.  My hospital, University of Chicago, rarely even uses regular angios anymore since CT angios came there.  The results are just as good, if not better.  In fact, yesterday I got to see my films from my CT angio a month ago.  WOW!  Those films were much more vivid, in 3D and color than my previous angio films.  I was impressed, not to mention I was thrilled not to go through all the regular angio stuff.  

I hope this helps some and I do want to urge you to inquire about some sort of testing considering your recent symptoms.  Sometimes, although rare, the surgery fails or the MM progresses despite surgery (I am one example) so it's important to check on the status of all this if you are having any new or continued symptoms.

Lisa

Lisa brings up a good point about CT-Angio's. I had one a few months back, no pain, just a IV line in the arm...basically the test is a standard CT with a tracer of iodine....test was over and done with in about 6 minutes and I drove home about 10 minutes later. However, I've been told that the CT-Angio results are NOT as goods as a angiogram. Does anyone have any insight into the quality of CTAngio versus a Cerebral Angiogram?

I'd appreciate any responses, as they are trying to get my angio scheduled.

Thanks,
Greg

Hi all:

Ditto Greg's question, as my understanding is that the CT Angiogram is not as detailed (I've done both).  Has anyone had a CT Angiogram done with Dr. Steinberg?  I'm curious to know if they do it at Stanford.  

Thanks Lisa for the explanation on why the angio hurts more pre-surgery.  I didn't really think about it but it makes sense.  I have my first post surgery angiogram in November and I'm not exactly looking forward to it, but it has to be done! ;)  

Trina

Hi everyone...

I had a few CT Angiograms, and like Greg mentioned, it's similar to a regular CT with an IV line.  I don't like it because I'm considered a "hard stick".  Even for blood tests, it's not unusual (if I don't have Karen or Gail, my favorite phlebotomists) for them to have to stick me 2 to 3 times just to get a blood sample.  Therefore, to get an IV is sometimes rough.  Nonetheless, I'd rather them poke me a few times to put in an IV than to have a cerebral angiogram...any day.  Oh, BTW, I also don't care for the warm sensation and metal taste I get from the dye...  [smiley=hurl.gif]  :-X

Thanks Lisa for explaining why Angios may not be so painful after surgery.  I'm sure hoping it's the case for me too! ;)

I too am curious about CTAs versus Cerebral Angiograms.  I had thought that cerebral angiograms provided the most detailed information, but I could be wrong.  I thought I'd try and look it up online, so to Google I went...and here's what I found so far..

"Unlike computed tomography (CT) or magnetic resonance (MR) angiography, use of a catheter makes it possible to combine diagnosis and treatment in a single procedure. An example is finding an area of severe arterial narrowing, followed by angioplasty and placement of a stent.

The degree of detail displayed by catheter angiography may not be available with any other noninvasive procedure."
http://www.radiologyinfo.org/content/catheter-angio.htm

CT (computed tomography) angiography (CTA) is an examination that uses x-rays to visualize blood flow in arterial vessels throughout the body, from arteries serving the brain to those bringing blood to the lungs, kidneys, and the arms and legs. CT combines the use of x-rays with computerized analysis of the images. Beams of x-rays are passed from a rotating device through the area of interest in the patient's body from several different angles so as to create cross-sectional images, which then are assembled by computer into a three-dimensional picture of the area being studied. Compared to catheter angiography, which involves injecting contrast material into an artery, CTA is much less invasive and a more patient-friendly procedure; contrast material is injected into a vein rather than an artery. This exam has been used to screen large numbers of individuals for arterial disease. Most patients have CT angiography without being admitted to hospital.  http://www.urmc.rochester.edu/smd/Rad/diagneuro.htm#CTAngio

Take care,
Shan

Wait..here's more...

Magnetic Resonance Imaging (MRI scan, MR scan)
An MRI scan shows the brain and spinal cord in more detail than a CT scan does. MRI can be used to diagnose ischemic stroke, hemorrhagic stroke, and other problems involving the brain, brainstem, and spinal cord.

Magnetic Resonance Angiography (MRA)
This is a special type of MRI scan used to see the blood vessels in the neck or brain. It can help determine the extent of damage. (My doctor usually orders this when I have an MRI done)

Carotid Ultrasound (Carotid duplex, Carotid doppler)This non-invasive test uses ultrasound waves – painless high-frequency radio waves – to take a picture of the carotid arteries in the patient’s neck and show the blood flow to the brain. It can show if the patient’s carotid artery is narrowed or blocked by atherosclerosis (hardened plaque buildup on the vessel wall).

Cerebral Angiography: (Cerebral arteriogram, Digital subtraction angiography [DSA])
Cerebral arteriogram is a more difficult test than carotid ultrasound, MRA or TCD, but the results are the most accurate. However, this method may not detect some aneurysms due to overlapping structures or spasm.

Computed Tomographic Angiography
CT-A is a recent development in diagnostic imaging for stroke that is poised to replace traditional cerebral angiography. It is much less invasive, as it does not require arterial catheterization, and results are available in about half the time. It can also catch aneurysms that cerebral angiography may miss. CT-A combines a regular CT scan with a contrast dye injected directly into a vein. The dye travels to the brain arteries, and images are created using a CT scan. These images show exactly how blood flows into the brain arteries.

Transcranial Doppler: (TCD)
TCD uses ultrasound waves to measure blood flow in some of the arteries in the brain.

http://www.theuniversityhospital.com/stroke/inhospital.htm

I've included more info. Hope this helps.  I would recommend, though, check with your individual MM specialist to see what he/she feels is the best test suited for you and your individual needs...as you know all our cases present differently.  [smiley=twocents.gif]

Take care,
Shan

Hi all,

Shan, very useful and interesting info you pulled up!

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CT-A is a recent development in diagnostic imaging for stroke that is poised to replace traditional cerebral angiography.

-- That is pretty much what they told me at University of Chicago when they suggested I have this instead of regular angio.  I asked repeatedly if the CT-A was just as good as the regular angio, not because I wanted a regular angio mind you [smiley=nono.gif] but I also didn't want to have the CT-A only to have them tell me later on it wasn't good enough and to go back and have the regular.  I was assured the CT-A was just as good.  But, like I said earlier, it is a newer test and not all hospitals are yet equipped to do the CT-A which brings me to the next question.


Quote:

Has anyone had a CT Angiogram done with Dr. Steinberg?  I'm curious to know if they do it at Stanford.

The last time I was at Stanford, December 2004, they were not equipped at that time to do the CT-A (I asked hoping!).  But, when I asked people at Stanford if my CT-A was good enough to send in to Dr. S they assured me that was fine.

Along another side note and please do not take this in a way it is not intended; while I adore Stanford in general, the care in the hospital, cleanliness etc.(much more so than the hospitals in Chicago for sure!) and I definitely know that Dr. S himself has much more knowledge about MM than University of Chicago, I have to say that in my opinion and experience there, the hospital itself is sometimes behind in some of their testing equipment/ideas (excluding the dreaded Xenon!  ;)) For example, I remember the first time I went to Stanford I was amazed that they were not yet using that patch thingy (forget the name now) during angios so that one does not have to lay there for 8 hours or so.  University of Chicago was already using that so that I was able to get up from the angio in two hours.  Believe me, this is NOT a put down about Stanford at all- that place is top notch!  Just a comparison that I've experienced along the long journey.  I'm sure University of Chicago doesn't have some things Stanford does (yep, like the Xenon!  [smiley=laugh.gif] )  In the end I guess, concerning the CT-A if your hospital doesn't yet have the capabilities to perform it then you don't have much choice in which type of angio you get. :)

Lisa

Greg,

First of all let me say that it's great to see you back on the board after your "mental break" and are back in there roaring to "git er done!".


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However, I've been told that the CT-Angio results are NOT as goods as a angiogram.

Do you mind me asking who told you that (a radiologist, surgeon etc.) and what reasons they specified of why the CT-A is not as good as the regular angio?  Just curious is all. [smiley=wink2.gif]

Thanks,
Lisa

Hi all,

I had my CT-A done at Hackensack Imaging Center in Hackensack, NJ. The test was requested by my neuro as an alternative to the angiogram reqeusted by Dr. Connolly. Unfortunately, there were a million issues with my insurance covering the angio, but not with the CT-A (lets read this as FREE....a rare find with my insurance company).  As an aside, I went to Hackensack Imaging because they have all of the newest and latest equipment...much better than the hopsitals in northern NJ....not sure about Columbia though.

It was my neuro who indicated that the quality may not be as good in the diagnostic phase of the MM game. He felt that it might not provide good detail in determining if small MM vessels are present, due to the dilution of the tracer injection. He indicated that the tracer may be too diluted to be picked up in small vessels because it has been "blended" into the blood stream by the time it reaches the brain...versus an angiogram which injects directly into the corodids.

My CT-A results are "suggesting" MM but neuro will not confirm without a angio. I am trying to get an appointment with Doctor Connolly for him to review the CT-A results and to determine if I need the angio...I'll keep you posted.

Has anyone had discussion along these lines with any of the MM doctors listed on here...

Lisa, its good to be back among friends...especially because you all understand that "just because you look good, doesn't mean you feel good".

Have a great day,
Greg