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CAT scan showed microvascular ischemic changes with calcified plaque in cartoid siphons. Meaning?

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My 59 year old mother was presenting symptoms of drooling with bladder spasms and incontinence. She was sent for a cat scan that said mild chronic microvascular ischemic changes with calcified plaque in cartoid siphons. What does that mean?
Posted Sun, 29 Jul 2012 in Brain and Spine
Answered by Dr. Neelam Ashish Vanjari 1 hour later

Thanks for writing in.

Carotid siphon is anatomical part of Internal carotid artery (ICA).

After coursing through the base of the skull, its first branch arises, the ophthalmic artery, which supplies blood to the retina. At the base of the brain, the ICA gives rise to the anterior and middle cerebral arteries. The site of this branching is often referred to as the carotid siphon.

As your mother is already having diabetes and hypercholesterolemia, both conditions are high risk factors for atherosclerosis; which in turn is responsible for ischemia [loss of blood supply to further tissue and damage].

The CAT scan shows that there are ischemic lesions at micro-vascular level [other small vessels], along with calcified plaque at carotid siphon; which can cause neurological signs and symptoms.

I hope I have answered your query. In case of doubt I shall be happy to help you.

Best regards,
Dr. Neelam.
Above answer was peer-reviewed by
Follow-up: CAT scan showed microvascular ischemic changes with calcified plaque in cartoid siphons. Meaning? 5 hours later
Thank you for your response. What does it mean in simple terms? Is that indicating XXXXXXX strokes, ms, or what? Is there a way to prevent further damage? Is the plaque dangerous? Thank you
Answered by Dr. Neelam Ashish Vanjari 25 hours later
Hi and thanks again,

I understand you are concerned, so I shall try and put across what's happening in simple terms.

Long standing diabetes and high cholesterol along with other factors such as smoking, high blood pressure and others increases risk of atherosclerosis. The scan revealed on such atherosclerotic plaque in the carotid siphon - which is an anatomical part of internal carotid artery within the skull. The detail of this artery is discussed in my previous reply.

Such plaque increases your chances of strokes in future. Now the scan finding reveal the small branches of this XXXXXXX carotid artery are not receiving significant blood supply probably due to this plaque and hence resulting in microvascular ischemic changes of the brain. This is like a ministroke happening due to gradual changes secondary to carotid siphon narrowing.

If not treated appropriately, this can result in stroke in future.

That being said, this is not an uncommon occurrence. An unnamed study done on a few patients with carotid siphon calcification revealed 30-40% patients with untreated carotid siphon calcification progressed to strokes in future. The numbers are significantly reduced with treatment. Treatment is usually blood thinner, diabetes and cholesterol management and treating any other risk factors which you might have.

Evaluation by a neurologist is necessary.

Hope it is clear to you. Let me know if you need any other information.

Above answer was peer-reviewed by
Follow-up: CAT scan showed microvascular ischemic changes with calcified plaque in cartoid siphons. Meaning? 25 hours later
Thank you. Would you be able to look at the mri I uploaded? She goes to the eye doctor this week. Could you explain in plain terms what it means, what type of diagnosis are we looking for, and is it treatable?
Answered by Dr. Neelam Ashish Vanjari 2 hours later

Thanks for writing in.

I have gone through the MRI report uploaded here.

The report suggests there are small ischemic areas in brain due to atherosclerosis as mentioned in our prior discussion. It will be taken care by giving drugs like blood thinners and risk factor correction.

Next step is to prevent your mother from vision loss, which occurs due to pseudotumor cerebri.

Optic nerve sheath is distended on MRI, which is likely to be due to age related brain atrophy. However, we need to rule out pseudotumor cerebri as a cause for it that is leading cause of blindness.

Pseudotumor cerebri occurs when the pressure inside skull (intracranial pressure) increases for no obvious reason.

With opthalmoscopy/fundoscopy; ophthalmologist can diagnose papilloedema [optic disc swelling], which is sign for pseudotumor cerebri.

Another finding is vestibular aqueduct prominence on right side; which part of inner ear. It is associated with cerebral aqueduct enlargement. Both this are indicative of enlarged brain pressure. We need to confirm it with detail clinical-neurological examination.

Our aim is to rule out diagnosis - pseudotumor cerebri and cause for enlarged vestibular aqueduct. So get ophthalmic and neurological examination done. If we find out cause, we can start medicinal treatment.

I hope I have cleared your doubt in simple terms.

Revert in case of any other doubt.

Best regards,
Dr. Neelam.

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