Understanding Carotid Artery Stenosis
A 42-year-old woman has been diagnosed with the following conditions: - Autoimmune Arthritis - Hypermobile Ehlers-Danlos Syndrome - Mild Sleep Apnea associated with hypoxemia - Chronic cervical radiculopathy originating from the C7 vertebra - Mild stenosis at C5, C6, and C7 - Osteopenia in the left hip - Irritable Bowel Syndrome (IBS) - Attention Deficit Hyperactivity Disorder (ADHD) Current Medications include: - Hydroxychloroquine - Adderall For approximately six months, she has experienced episodes characterized by ear congestion and feelings of lightheadedness during walking, exercising, or other physical activities, often requiring her to pause or lean on something for support. Initially occurring twice a month, these episodes became weekly and have now escalated to a daily occurrence. While her insurance declined coverage for brain imaging, they did authorize a carotid Doppler ultrasound. The results indicate that there is stenosis ranging from 50% to 69% in the distal right internal carotid artery, and the proximal left common carotid artery, as well as the left internal carotid artery, are also affected in the same range. Given this diagnosis, she wonders if it could explain her symptoms and whether it would be worth appealing the decision regarding imaging. Despite having low blood pressure, normal blood sugar levels, and healthy cholesterol numbers, the stenosis results were unexpected. Additionally, she experiences other neurological symptoms, including numbness, which she suspects may stem from a previously undiagnosed pinched nerve. She is seeking advice on pertinent questions to discuss with her primary care physician during their next appointment. Any suggestions or insights would be highly valued. 😊
Answers (1)
8/22/2025, 11:01:13 PM
OpenHealth AI
It's understandable that you're feeling concerned about your recent diagnosis and symptoms, especially given the complexity of your condition. Carotid artery stenosis, particularly in the range of 50% to 69%, can lead to reduced blood flow to the brain, which might explain your episodes of lightheadedness and ear congestion. Let’s break down the key points and provide some actionable steps for your next appointment with your primary care physician.
Key Points:
- Symptoms Connection: Your symptoms could indeed be related to the carotid artery stenosis. Reduced blood flow may lead to dizziness, especially during physical activities.
- Potential Neurological Impact: The presence of other neurological symptoms, such as numbness, may warrant further investigation to rule out other contributory factors.
- Need for Brain Imaging: Given the severity of stenosis and your symptoms, there is a strong case for appealing the insurance decision regarding brain imaging to fully assess your condition.
Next Steps:
-
Questions to Discuss:
- Could the carotid artery stenosis be causing my lightheadedness and ear congestion?
- What neurological evaluations do you recommend, especially for my symptoms of numbness?
- Given my medication and health conditions, how can we safely manage the stenosis? Should lifestyle changes be implemented?
- What are my options for appealing the insurance decision on imaging? Is there urgency in obtaining brain imaging?
-
Prepare for the Appointment:
- Symptom Diary: Track your episodes of lightheadedness, ear congestion, and any neurological symptoms like numbness. Note the timing, triggers, and duration of these symptoms to share with your doctor.
- Medication Review: Write down all current medications and any side effects you are experiencing, as this information may help your doctor assess treatment options.
-
Lifestyle Considerations:
- Maintain hydration and a balanced diet to optimize overall health. This can be particularly important in managing symptoms related to chronic conditions like sleep apnea and IBS.
- Discuss with a physical therapist about exercises that can improve your stability and reduce the risk of falls during episodes of lightheadedness.
Follow-Up Actions:
- After your appointment, follow up on the appeals process for brain imaging if necessary.
- Consider a referral to a neurologist for further evaluation of your neurological symptoms.
Your proactive approach to understanding and managing your health is essential. Don't hesitate to share all your concerns during the visit. Wishing you the best in your discussions with your doctor! 😊
Related Questions
Experiencing Clear Fluid from Ear with No Discomfort: Should I Wait for My Appointment?
I am a healthy 57-year-old female, weighing 120 pounds and standing 5 feet 5 inches tall. My daily medications include 100 mg of Losartan for effectively managed high blood pressure, 200 mg of Lyrica taken twice daily for post-herpetic neuralgia, 100 mg of Synthroid following treatment for thyroid cancer, and a combination hormone replacement therapy patch. Additionally, I take Zyrtec and Flonase every day to combat allergies. Since October, I have been dealing with persistent tinnitus in my right ear, accompanied by some pressure and a muffled sensation. Recently, I've noticed that when I speak, it feels akin to the sensation I experience when my ears clear during a flight after chewing gum—my voice sounds amplified in my head. I've scheduled an appointment with a physician's assistant in an ear, nose, and throat (ENT) office for the end of March due to my worries about the tinnitus and any potential hearing impairment. Yesterday, I noticed that my ear emitted a clear fluid. Thankfully, there was no associated pain. The fluid was somewhat thicker than water, completely odorless—unlike the unpleasant discharge I recall from my daughter's ear infections—and there was no sign of blood. Could this indicate a perforated eardrum? I suspect this might be the case, but can this occur without an underlying infection? Should I seek attention sooner than my appointment in March? I would prefer to avoid urgent care during flu season; however, if this situation is serious, I am prepared to take precautions and visit.
Understanding the Increased Pain in My Foot While Reclining
At 30 years old, I am nearing the five-week mark since undergoing surgery on my metatarsals. I've encountered a troubling issue: I can’t seem to find comfort when lying down, whether it’s with my foot raised or lying flat. My pain level escalates to a severe 10 out of 10, unless my foot is making contact with the floor or I dangle my leg off the side of the bed so that my toes touch the ground. Is this situation typical for someone in my circumstances? Are there any suggestions that might assist me in getting a better night's sleep?
Assessing My Health Concerns: How Anxious Should I Be?
I’m a 32-year-old woman, weighing 124 pounds and standing at 5 feet 6 inches tall. For over a year, I have been experiencing bright red rectal bleeding. Initially, I attributed this issue to hemorrhoids that developed during my pregnancy two years ago. The bleeding occurs with most of my bowel movements, sometimes happens without one, and on a few occasions, has been enough to stain the toilet bowl significantly. The color of the blood is typically darker than what I observe during a hemorrhoid flare-up. There is a notable family history of bowel cancer on both sides; one family member was diagnosed at age 45, and another at 60. In the past six months, I have encountered several episodes of severe abdominal pain—3 to 4 instances—intense enough to consider a trip to the emergency room. However, the pain usually subsides within about an hour. It’s unusual for me to experience such acute pain, given my high tolerance for discomfort; for example, I once played rugby shortly after dislocating and fracturing my finger. Recently, I mustered the courage to consult with my doctor, who recommended a FIT test, which returned a positive result (30.1). Additionally, I underwent a complete blood test, and aside from having low ferritin levels (7 µg/L), all other results were normal. I have since been referred for a colonoscopy on a two-week waiting list to rule out any possible bowel cancer. Given these circumstances, how concerned should I be? Thank you for your input.
Persistent Pain in Right Shoulder and Arm After Lifting
Hello, everyone! I’m a 23-year-old male and have been engaged in weightlifting for several years now. Recently, I’ve been struggling with ongoing discomfort in my right shoulder and arm, which I haven’t been able to accurately identify. The pain manifests during particular movements, especially with lateral raises or when my arm is raised to shoulder level while rotating my wrist. Certain pressing and pulling activities can also provoke this discomfort. Rather than feeling sharp, it’s a deep, nagging sensation that sometimes seems localized in the front area of the shoulder or at the biceps tendon, and at other times it feels more like it’s situated between the shoulder and upper arm. Fortunately, there’s no numbness or tingling involved. This issue began while I was working out. I decided to take a break for around two months, but when I returned, the pain persisted. After consulting a physician, I was diagnosed with bicipital tendinitis. Since then, I’ve reduced my upper-body workouts, completely steering clear of shoulder exercises and heavy lifting, and have begun a gentle rehabilitation regimen focusing on external rotations, pendulum movements, and scapular exercises. Despite adhering to this routine for about a week, I haven’t experienced any noticeable improvement. Is it typical for this type of tendon injury to require an extended period for recovery? At what point should I consider diagnostic imaging, such as an ultrasound or MRI? Additionally, are there frequent rehabilitation errors that might impede the healing process? I appreciate your insights in advance!
Understanding EEG Results for My 22-Month-Old Son: Insights Needed
Could someone help clarify this for me? My son, who is just 22 months old, hasn’t started walking yet, becomes tired easily, and has been experiencing behavioral outbursts. He had a febrile seizure in February 2025, followed by another unexplained seizure in April 2025, which led us to consult a neurologist. Since he was 3 months old, he has been receiving therapy from a physical therapist for torticollis. At birth, he spent five days in the NICU due to issues with meconium aspiration. A recent MRI showed normal results, and he also had a follow-up EEG after one conducted in July 2025. The results from this recent EEG were abnormal for a pediatric patient in awake, drowsy, and sleeping states. Notably, there were brief episodes of left frontotemporal delta slowing, which occurred mainly when he was awake and drowsy. There were no signs of epileptiform activity detected. In contrast, the EEG performed back on July 3, 2025, was deemed normal for both awake and drowsy states, again with no evidence of epileptiform irregularities, although it did not capture any sleep data. This examination was prompted by the child's existing history of febrile seizures. Importantly, he is not currently on any anti-seizure medications. The EEG procedure used standard electrode placements per the 10-20 system, conducted a single-lead EKG, and included continuous video monitoring. During the analysis, the background activity was symmetric, indicating some anterior-posterior (AP) organization, with a dominant rhythm of 50-80 microvolts at 7 Hz. His drowsy state was marked by a reduced amount of eye blink activity, less breathing motion interference, and a generalized slowing in theta/delta frequencies. Stage II sleep exhibited spindles and vertex waves patterns. Additionally, there were intermittent bursts of 250-300 microvolts in the left frontotemporal region with semi-rhythmic activity of 2-4 Hz, mostly observed during wakefulness and drowsiness. No definitive epileptiform discharge was noted. Photic stimulation during the test did not elicit a strong response, and hyperventilation was not conducted during this session.