Concerns About Possible Brain Pseudoaneurysm
I am a 34-year-old female currently managing a variety of medications that include:B - Amitriptyline HCl 45 mg (for chronic migraines) - Blisovi 24 Fe (birth control) - Alprazolam 0.5 mg (taken as needed for anxiety during flights) - Loratadine 20 mg (over-the-counter allergy relief) - Omeprazole 20 mg (used occasionally for GERD) - A daily multivitamin - Medical cannabis. In terms of my medical background, I have been coping with chronic migraines without aura, treated with amitriptyline. My history also includes a concussion from a car accident in 2017, and I sometimes experience gastroesophageal reflux disease (GERD). Recently, I have developed pulsatile tinnitus affecting both ears, which began in late July. This condition is accompanied by a feeling of pressure and throbbing in my head, occurring sporadically after coughing, rising from my chair, exercising, and even waking me from sleep. Following a visit to an internal medicine specialist, I underwent an MRI/MRA examination both with and without contrast. The results are detailed below. I am also scheduled for a CT Angiography of the head, again with and without contrast, next week and will consult with a neurosurgeon, Dr. Burkhardt, in early October. Notably, there is no family history of aneurysms. I am seeking insights regarding the MRI results: What is your perspective on the diagnosis? Is it possible to consider alternative explanations for my symptoms? If it turns out I do have a pseudoaneurysm, what precautionary steps should I take to minimize the risk of rupture? Should I be alarmed about the possibility of sudden complications before my upcoming appointment in October? My anxiety is quite elevated regarding this situation. Radiology Findings: - **MRA of the Brain:** Normal blood flow observed in the main arteries of the circle of Willis. No significant stenosis, occlusion, or saccular aneurysms are present. However, a small fenestration was noted in the left M1 segment. A broad outpouching from the proximal left petrous internal carotid artery measures approximately 2 x 4 mm. - **MRA of the Neck:** The origins of the great vessels appear normal. There is adequate enhancement in the common and cervical internal carotid arteries bilaterally, with no stenosis at the carotid bifurcations. The vertebral arteries are also normal. **Assessment:** 1. A 2 x 4 mm outpouching from the petrous ICA, possibly suggesting a small pseudoaneurysm that requires further assessment via CTA of the head. 2. No significant stenosis or occlusion is observed in the major vessels of the circle of Willis. 3. There are no notable stenoses or dissections in the major cervical blood vessels.
Answers (1)
8/27/2025, 5:55:10 PM
OpenHealth AI
It's understandable to feel anxious about your health, especially with concerns regarding potential vascular issues. Based on your situation, there are several key points to consider regarding your MRI/MRA findings and your symptoms.
Key Points:
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MRI/MRA Findings:
- The small outpouching noted (2 x 4 mm) on the proximal left petrous internal carotid artery may indeed suggest a pseudoaneurysm, but no definitive diagnosis can be made until after your CT Angiography (CTA).
- Importantly, no significant abnormalities were detected in the main arteries of the circle of Willis, which is reassuring.
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Understanding Pulsatile Tinnitus and Head Symptoms:
- Pulsatile tinnitus can be associated with vascular abnormalities but can also arise from other factors such as hypertension, changes in intracranial pressure, or even stress.
- The feelings of pressure and throbbing might be linked to headaches or migraines, especially since you have a history of chronic migraines.
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Monitoring and Precautions:
- Sudden complications from a small outpouching like a pseudoaneurysm are rare, especially if there are no additional risk factors noted (like high blood pressure or a significant family history).
- Keeping symptoms like severe headaches, sudden changes in vision, or neurological signs in mind can help you remain vigilant.
Next Steps:
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Await the CT Angiography:
- Make sure to discuss your symptoms and MRI/MRA findings with your neurosurgeon during your upcoming appointment. The CTA will provide more clarity on the nature of the outpouching and confirm any concerns regarding a pseudoaneurysm.
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Manage Anxiety:
- Consider techniques to manage your anxiety, such as mindfulness practices or deep breathing exercises, especially as you await further testing. Staying informed can help but try to avoid excessive research that may increase your anxiety.
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Monitor Symptoms:
- Keep a log of any new or worsening symptoms, especially changes in your pulsing tinnitus or headaches.
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Follow-up with Medical Care:
- Maintain your scheduled follow-ups and ensure open communication with your healthcare providers. If you experience acute symptoms, don’t hesitate to seek immediate medical attention.
Final Thoughts:
You're doing the right thing by seeking further evaluation and maintaining regular appointments. The likelihood of significant issues from a small outpouching is generally low, but awareness and monitoring are key. It’s okay to feel anxious—taking proactive steps tends to help alleviate some of those concerns. If you have further questions or need to discuss symptoms in more detail, feel free to reach out.
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