needed: radiologist/neuroradiologist/vascular professional online
August 16, 2005 3:35 AM   Subscribe

I am looking for a radiologist (or neuroradiologist) and a vascular professional that answers questions on the web.

I have a question about neck MRI and MRA I would like to pose to a radiologist (or neuroradiologist) and another question on cerebral and vertebral vascular testing I would like to pose to a vascular professional (or neuroradiologist).

I've searched and searched and haven't found a forum or a questioning service (or even an email) of any of these kinds of specialists. Could anyone point me to one?
posted by mirileh to Health & Fitness (12 answers total)
My strong feeling is that you won't find a forum, open to the general public, as such. There's a few places where you can ask general medical questions. The basic answer I imagine is that ordinarily professional people, particularly those dealing with health, both need to examine a person and take a detailed history before providing specific information. Or it would be usual to ask those questions from the professional involved in your care, if you have them. You could otherwise ask your GP if they have email contact with any of these specialists, should you questions not be pertaining to a patient's care, per se.
Perhaps you can pose your question here anyway. It may be that someone passing through will have a cogent response.
posted by peacay at 4:07 AM on August 16, 2005

If your questions are of an informational nature, and not a request for medical advice, I'd be happy to take a crack at them. If I don't know the answer I'll find it out for you.
posted by ikkyu2 at 7:44 AM on August 16, 2005

This article talks about online services where you can get a second opinion, although they point out that the AMA still has doubts about this sort of thing. The service the article seems to talk most about is Partners Telemedicine, where you can have your doctor send in your records and get a specialty consultation.
posted by MsMolly at 9:24 AM on August 16, 2005

Response by poster: Ok ikkyu2, I'll take a crack at the vascular imaging question -

I wanted to know if there is any way to check vertebral blood flow in the following position: the patient is upright and partially bending his/her head forward (the neck extensors are statically holding the head up).

Now before you throw Doppler at me, problem with Doppler is that the technician presses on the patient's neck/head, pushing it down to a full flexion of the neck (and out of the desired position).

Is there any variation of Doppler that requires less/no pressure? If not, it there any other vascular imaging that can check this position (from what I understand the patient is supine in all MRA, CTA and Catheter Angiography)?

(a thought: I know this sounds like going backwards in technology, but won't an X-Ray with contrast material do the trick?)
posted by mirileh at 11:17 AM on August 16, 2005

The "requirement" for flexing the neck to do vertebral Doppler is more based on the patient's unique anatomy. Vertebral doppler is itself not so reliable, and if the patient is a big, beefy person with a lot of fat and muscle back there, flexion may just be necessary to give the ultrasound waves a straight shot at the doppler.

The table in the neuro-angio suite at Columbia tilts; you could pretty much get folks upright. There are, however, significant dangers to shooting vertebral angio in the best of times; intentionally kinking the vessel positionally sounds like a recipe for turbulence, which causes vertebral dissection. Vertebral dissection is VERY BAD.

There are a few upright MRI scanners around; most, if not all of them use OpenMRI technology and consequently have low field and pretty crummy coils. I don't think you can get good enough MRA with any of these to see a tiny little vert (bear in mind the inner lumen of these vessels is only 2mm wide at best, and you're looking at flow void in there.)

X-ray with venous contrast injection won't work. The verts are arteries. You can't put enough contrast into the entire vascular system to light up all the arteries; only direct injection works, which is what catheter angio is.

Bottom line: if I were trying to diagnose a position-related vertebral artery obstruction (the published literature on these is mostly found under the obscure name, "bow hunter's stroke"), I would talk to a skilled interventional neuro-radiologist about exactly what I needed, which would be some positional catheter angio studies. Three folks I've met in my career whom I'd trust to perform the study you're describing are John Pile-Spellman and Sean Levine, both at Columbia; and George Teitelbaum, who was at USC long ago but may be elsewhere now.

Hope this was helpful.
posted by ikkyu2 at 1:13 PM on August 16, 2005

One reason you'd have to talk this over with the radiologist in question is that pressure injection could unkink an artery enough to allow contrast flow.

Actually, as I think more of it, I'd be unlikely to order such a study. I'd make the diagnosis clinically. What made you think such a thing might be useful?
posted by ikkyu2 at 1:15 PM on August 16, 2005

Response by poster: ikkyu2, first of all, that was very helpful, thanks!

maybe I should have mentioned what I suspect and why the specific position.

I don't suspect atherothrombotic disease or an artery disorder per se. I suspect damage to vertebral ligaments causes changes in the positioning between vertebras, distorting or twisting the spine in a way that puts pressure on the vertebral arteries thus lowering blood flow (same as twisting an intact water hose will lower water flow). Why the specific position? Symptoms of near syncope and nausea only appear in this position. I suspect it's occurs only on the constellation of cervical spine flexion with the contraction of the neck extensor muscles (holding the head up).

With that being my suspicion, I intended to steer clear of catheter angiography, which if I'm right, is not only unnecessarily invasive, also will not help me (I don't suspect an inner obstruction). Having said that, which testing can sufficiently check out this suspicion?
posted by mirileh at 12:05 AM on August 17, 2005

Have a competent neurologist examine the cranial nerves during the symptoms, if they're reliably reproducible. If there is truly vertebral artery compromise sufficient to cause near-syncope, there will be other findings.
posted by ikkyu2 at 1:43 PM on August 17, 2005

Response by poster: thanks again! that sounds very logical.

it has surprised me all along that none of the doctors I've seen has done any testing (heart rate, blood pressure, or even note if any change in the color of my face) in the position that is problematic. i would have thought that basic.
posted by mirileh at 3:28 AM on August 18, 2005

Well, so would I, but then again, neurologists are still taught to examine our patients. It is a dying art.

Hope you get your problem sorted out.
posted by ikkyu2 at 12:17 AM on August 19, 2005

Response by poster: thanks!
posted by mirileh at 12:20 AM on August 19, 2005

Response by poster: just in case anyone comes back here, an online consultation site is here -
posted by mirileh at 6:01 AM on November 12, 2005

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