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Thrown from horse and had TBI. Experiencing falls. Due for medical tests. Should I go for carotid Doppler test?

May 2014
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Practicing since : 2002
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I am a 61yo female, retired RN and started having falls without any warning in advance over the last year. Eight months ago I had TBI after being thrown from my horse. There was no definite cause diagnosed after numerous tests. I'm scheduled to have another EEG, tilt table, and vertigo rehab because I have fallen three times in the past 2 weeks. I'm wondering if carotid doppler should be advised?
Posted Mon, 28 Oct 2013 in Brain and Spine
Answered by Dr. Vivek Chail 5 hours later
Brief Answer:
Carotid Doppler for vertebrobasilar insufficiency.

Detailed Answer:
Thanks for writing in to us.

I have read your query in detail and understand your situation.

As we are talking about you having fallen off a horse and traumatic brain injury, I presume a CT scan brain has been done and no major head injury reported. Very often repeated falls can mean cerebellar and/ or inner ear dysfunction and need to be investigated.

Carotid Doppler is an investigation that I regularly do on patients with usual history of dizziness and syncopal attacks. It is a simple and non invasive imaging test where the common carotid, XXXXXXX and external carotids and vertebral arteries blood flow are studied using ultrasound techniques. It shows the luminal flow and any velocity disturbances. Luminal obstruction caused by plaques are also well studied. Any insufficiency in the flow of blood in the vertebral arteries which can cause abnormal flow in basilar artery which finally supplies the cerebellum and posterior brain circulation. Therefore vertebrobasilar insufficiency can be evaluated by Carotid Doppler.

Vertebrobasilar disease is a broad classification describing the condition where there is an insufficient delivery of blood flow via the vertebral and/or basilar arteries to the brain.

Atherosclerosis or "hardening of the arteries" is the primary cause of vertebrobasilar disease. The narrowing of the vertebral or basilar arteries caused by atherosclerosis creates vertebrobasilar insufficiency (VBI), or an insufficient delivery of blood flow to the posterior structures of the brain.
As a result of decreased blood flow, the symptoms of Vertebrobasilar Disease are varied and are often referred to as a whole as vertebrobasilar insufficiency (VBI) or vertebral basilar ischemia. The symptoms can include: vertigo (dizziness), visual disturbances (blurring, graying, double vision), drop attack (sudden falls), numbness or tingling and slurred or lost speech. Since the portions of the brain most typically impacted are responsible for movement and balance, symptoms of VBI can often result in falls.

Hope your query is answered.
Do write back in case of doubts.

Above answer was peer-reviewed by
Follow-up: Thrown from horse and had TBI. Experiencing falls. Due for medical tests. Should I go for carotid Doppler test? 4 hours later
I want to thank Dr. Viverk Chail for the information about the possible cause of my symptoms. I will be calling my neurologist and request more doppler studies.
I fell again last night after I accessed this site.

Thank you.

Answered by Dr. Vivek Chail 6 hours later
Brief Answer:

Detailed Answer:

You are most welcome and thanks for your feedback.
I guess your neurologist will be able to help you out with the carotid Doppler.

Wishing you good health.

Above answer was peer-reviewed by
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