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Feeling pins and needles in arms, tightened throat. CNS VASCULITIS?

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Hello Dr Neurologist

A year ago i was suffering from throbbing left posterior side probably left vertebral for some time( i have HBP for the past 5 years old patienti take atenelol for it and also i had same throbbing in the same area), also after that in august of last i year i woke suddenly in the middle of the night with my right side all pins and needles and i was not feeling well, the 20 seconds later suddenly my throat got tightened for some time then it went up to my head posterior got tightened then lastly my right side of my tongue got tightened and squeezed all really hard, the next days i was tired with symptoms like my tongue and hands pins and needles...etc, 5 days later i went and did in the US an mri and mra, that showed no bleeding
I know i had a stroke that the image missed but i have no prove, but the question is could it be more probable a bleeding stroke or more like a clot from a left vertebral dissection or both left vertebral dissection aneurysm
SO the doctors gave me convulex , gebapentin...etc, with no improvement, i had strange symptoms after that event , facial nerve pain strange sensations... all are brain stem related
Days passed with some improvement and the throbbing went down to only 10 percent mild
then they decided to do an invasive angio for me , here is an important point when they inserted the cather on left and right carotid and right vertebral and injected the dye nothing happened, i felt normal, when they injected the dye in the left vertebral i felt some pain or something, the angio was normal , but what happened next is the throbbing went back to be 100 percent and even more, i became very ill my head left side was shaking, and suddenly my heart started acting strangely as if i will die , ear pains tongue facial....etc i went to the hospital er , icu... then went out, once they told me maybe inflammation arteries , then said cns vasculitiis, then we do not know migraine , all blood tests ruled out those diseases LP also and i have no migraine , also tried many medicines topamax...etc with no improvement....., but i know it was non, i know it is either a dissection got triggered back by the in injection of the dye or fusiform aneurysm or both
So i am here now with same symptoms brain stem, pins and needles, tongue ear painful pains, even when i bend down then up my ears hurt, back left posterior is throbbing and hurts, and my left leg and hand in continuous tremor , i even can not sleep well because when i lie down with my head symptoms and throbbing increase in different postitions, so also again maybe i had a small bleeding and or small clots from dissection...etc
Anyhow they did after weeks of the invasive angio an mra and mri with no contrast and the only thing they told me is we found that the left vertebral is big, some said it is just dominant by birth , others said might some dialtation
so i know for sure the thorbbing is coming from this thing the dialtation and this might be a dissection or and aneurysm that might bled and will again and this dialtation maybe pressing on the nerves there also

and i know my symptoms are related to autonomic difuntion, medulla oblengata, vugus nerves, cranial nerves...
and i know i am very sick and ill like dealy can not do much, and i know this area is fatal , and this area is very fragile for me anything triggers it and irrtates it
but i do not know what to do , they all agree with the brain stem symptoms and bigger left vertebral artery before the PICA, i asked for stenting coiling , some said no some said yes some said leave and pray
I do not know what to do, i told you my story and symptoms and i will only attach 7 images of the left vertebral , maybe you can look and tell em what to do, i even see small bulging at the corner of the artery in one of the images if you look carefully at the maginfied ones
also if there is a medication or anything to strengthen the artery wall but not dialate or thin the blood i am afraid of bleeding, it is very fragile, i dont think i can survive another angio injection in that area
Please tell what is your opinion in this case, i live in a daily agony for a long time

Also do you think if i consult a neurosergeon about this situation and images attached it would be helpful because they can see the images and they open brains and see the real thing and assess , maybe they got same images, symptoms and situation with other patients and figured out what to do , i know this site has no neuroradiologist or intervention radiologist to consult

Thank you

Category: Neurologist, Medical

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Category: Pediatric Neurologist
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Thank you for choosing DoctorSpring. I have thoroughly analysed your concern and medical history. I discussed with my interventional colleagues too. The first episode of symptoms you had is very unlikely form stroke. Infact none of your symptoms suggest stroke. In the first episode you had the imaging investigation after 5 days. So that would have picked up any bleed or infarct. I can most certainly say that was not a stroke . And there is a no way a brainstem stoke will be missed clinically + radiologically. Your two predominant symptoms pins and needles + pain suggest a neuropathy aetiology. Something to do with the nerves outside the brain rather than the brain or brain stem. When I state this, I do take into consideration the symptoms you had during dye injections. So it is possible that there is some vasulitis (limited vasculitis) in the left vertebral artery which could be related or unrelated. I don't think there is a aneurysm or dissection. Having seen lot of aneurysm and dissection I would trust clinical symptoms + imaging studies to make a diagnosis. In your cases both are not suggesting. I would not recommend any intervention without a confirmed diagnosis.

I would like what is the most troubling symptom right now ? (or most troubling 2 or 3 symptoms ?). Also is there any trouble in swallowing or speech ? Any weakness of arms / legs (right now )?
Also have been tested for neuropathy ?

You can reply as a followup
These information will help me in making a better diagnosis.

Thank you

Patient replied :

Hello, Thank you but i know that small bleedings can be missed in images specially an mri , a ct is more accurate, so what was that event , because after that event everything changed i have continuous pins and needles , facial pains, left side tremor....etc. I told you this and i suspect a weak vertebral because of the dialtation, and because i have HBP and the throbbing was in the same area, so it must be bleedings and not small clot, more probable SAH When you say Vasculitis , do you mean it will go away by it itself , because this area left vertebral is so fragile and it can be very weak, or do i need steroids because i tried steroids for 6 days and i did not improve, it was 20 for 2 days then down to 10 for 2 days then down to 5 for two days then stopped but no improvement, I know vasculitis needs a longer period of time to treat and also the arteries on the images look like beaded but not necesserly You mean the dye triggered it back again, any pillls triggers again, so i should avoid any medicine Here is another point when i check my BP and the machine squeezes my arm whether during or directly after it finished my left back side of my head hurts and my ears hurt, could it be a nerve injury or vasculitis or both because even when the MRI machinne goes above the left side i feel pain like nerve pain Some times when i eat somnethings like trumeric garlic or take pills they used to give me this area also get irritated and give me symptoms. it is very fragile I do not know what do you think of all that, by the way i did an LP and ENA blood test ANA ANCA ...etc all came normal To answer your questions, the most 3 symptoms that are troubling me are throbbing left vertebral with nerve irriated pain in that side can not sleep from it Left leg and hand unvouleterly tremor Second facial pains specially the ear pains or when i bend and get up again All my symptoms are are related to left vertebral medulla oblengata, vugus and cranial nerves but i have no proof because i had strange heart beatings stops and breathing unvolunterly also For a trouble in swallowing and speech , yes i had when my situation was very very bad after the angio the throbbing was to the extreme but now the swallowing and speech are better and ok, aslo i had trouble after that event last year that you do not call a stroke No weakness in arms or legs , and no not tested for neuropath but i doubt i have, i have brain stem symptoms and it left vertebral artery pathology related but my problem i have no significant proof inside the brain I have a question and please answer me back about my latest MRA without contrast for detecting a dissection, i heard that it can miss a dissection in the left vertebral, do you think i should have a brain mra with contrast to catch if there was a dissection
DId you look at the image number 222 , it is clearly dialated , this is the weak area, did they sent it to you because i could not upload it Do you know of any supplement or medicine to strenghten the artery but not weaken it or thin the blood , to strenghten the artery walls Thank you


The fact is that if you are really having a vertebral artery pathology there should be definite clinical signs or radiological signs . I am sure you have been examined by a Neurologist. The imaging studies are not suggestive and your signs are not specific. I think you should take this a very good news. I do appreciate appreciate the size difference in the MRI, but that in isolation has not much meaning. When I said vasculitis I was suggesting a possibility which needs evaluation. Since evaluation did not turn anything positive I do not think any therapy is necessary. Your symptoms again the major ones - point towards a neuropathy like a Trigeminal neuralgia.It is not possible the feel the pain via an artery under normal circumstances.
And no to answer your specific question there are no medication that would strengthen an artery.

I am pretty sure that your Doctors have also given a similar reply. What I would suggest is a neurpathic medication, pain meds and an anxiolytic. You can get in touch with your Doctor for this. Give it some time - couple of weeks and lets see how this evolves or resolves. I will keep this consult open and you can review with me. Once again I assure you that there is nothing major woring with your vertebral artery or brainstem. Please be relaxed.

Hope this helps
If you have more queries feel free to ask .
Thank you

Patient replied :

I will close the consultation and ask you a new question the coming days and update you but before that, since images are not showing evidence of aneurysm dissection, and because of my facial pains cranial nerve pains pins and needles face hands feet tremor...etc it all suggests brain stem medula left vertebral problem, it is my body I know I am seriously ill, and there is a big probability it is Cns vasculitis PACNS and it will only show with biopsy
you know the dye of the angio and pressure triggered it, even the Iv irritates this area like sodium , and I did not say hurting artery I said throbbing hard but the nerves are hurting maybe there damages or insulted
i even have noticed that when for example have some lemon or garlic or other different thing, even baby aspirin that area left vertebral nerve hurts more and facial symptoms increase even the throbbing increase , and this in normal people should not happen at all, the dye thing nor lemon or onions nor......
so I think there is vasculitis in that artery and it gets triggered more by these things and irritated the nerves, and also maybe I have leaky gut that gives more inflammation to that area and allergy
beleive I know my body I have something in that artery that not seen by images just some dialtation cause by the inflammation
and I really do not know what to do, because it can only be diagnosed with biopsy, and if I take cox2 inhibitor it might worsen it if it real vasculitis , so maybe immune suppresser , they should give me that
i don't know if people with Cns vasculitis in the left vertebral when they inject dye to them causes more throbbing or some trumeric or lemon
what do you think and recommend


Thank you for the reply. I have checked the literature and data on whether the dyes can precipitate symptoms if there is pre existing vasculitis, but I couldn't come across any similar reports. Even I feel this is unlikely. However the best option right now would be a followup. I recommend you to take the medication I have mentioned in consult with your Doctor. Have review after few weeks (4-6 weeks). This review should include a complete neurological examination. So if there is any brain stem finding or cranial never involvement it will be picked up for sure. The reaction to gralic and baby aspirin again favour a peripheral nerve problem , because these nerves conduct those signals first. There is no solid evidence of vasculitis so you can take COX 2 inhibitor.
May I know what all medications you are curretly on ?

Hope this helps
Feel free to ask followups
Thank you

Dr. Sudhir Kumar
Category: Pediatric Neurologist
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
Dr. Sudhir Kumar and 4 other Medical Specialists are ready to help you

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