Blog, IIH

Cerebral angiograms used as a tool for Intracranial Hypertension

What is a cerebral angiogram?

“In cerebral angiography, a thin plastic tube called a catheter is inserted into an artery in the leg or arm through a small incision in the skin. Using x-ray guidance, the catheter is navigated to the area being examined. Once there, contrast material is injected through the tube and images are captured using ionizing radiation (x-rays).”

(taken from https://www.radiologyinfo.org/en/info.cfm?pg=angiocerebral)

Why is it used for IIH?

Many patients with intracranial hypertension have stenosis in the veins that are responsible for draining CSF and blood from the brain. This basically means your veins are collapsing and not allowing adequate blood/CSF flow. Doctors are not sure whether the stenosis causes the intracranial hypertension, or if the intracranial hypertension is causes the stenosis—though they do know that many patients benefit from stenting these collapsed veins.

A cerebral angiogram/venogram allows your neurosurgeon to measure the pressure gradients across your veins, which is a very accurate way of finding how much stenosis really exists.

Surprisingly, my MRV (special type of MRI that shows the veins) showed mild stenosis in my right transverse/sigmoid junction but my cerebral angiogram showed severe stenosis. An angiogram is much, much more accurate than an MRV or CTV.

I had 2 stents placed immediately following my angiogram, but I’ll describe that process in another post.


What is the angiogram like? Will I be awake?

According to my neurosurgeon (Dr. Athos Patsalides) at Weill Cornell, it is very important that patients are awake during cerebral angiograms, because results can be inaccurate if you are fully sedated. This opinion may vary among other doctors.

Having a procedure where they go up into your brain through your leg while you’re awake can be nerve-wracking. I remember being in pre-op thinking “I wish they would just knock me out for this”. I typically don’t get very nervous or anxious over medical things—but I’ll admit I was a bit nervous for this one, just because I had to be awake for it.

When took me back to the OR, there were doctors and nurses in the room suiting up like for a surgery. It seemed kind of intense but I kept pretty calm. They gave me some partial-sedation medication through my IV.

All I remember about the procedure feeling the poke/burn of the lidocaine, hearing the doctor say “you may feel something in your head in a second” (and I did...just a weird pressure sensation), and next hearing the doctor say “we’re doing it!” (meaning putting the stents in). Then they put a mask over my face to knock me out.

It’s not the most comfortable or fun procedure that’s for sure. I’d probably compare the discomfort level to getting a spinal tap—just with a bit more nerve-wracking since they’re going up into your brain.

If you’re nervous for your angiogram, just know it will be okay, and like me, you probably won’t remember most of it!

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