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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 7201
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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Right Internal Jugular Vein/Sigmoid Sinus Thrombosis???Is

Customer Question

Right Internal Jugular Vein/Sigmoid Sinus Thrombosis??? Is anybody willing to look at my MRI images which were taken 2 weeks ago (still waiting for the report) and confirm/disprove my theory?? Symptoms began 5 months ago - sudden right head and neck pain, nausea, palinopsia, tinnitus (left-ear, high-pitched ringing), general confusion, sudden very bad balance, moods swings...










Submitted: 2 years ago.
Category: Neurology
Expert:  Dr. Frank replied 2 years ago.

neuromd2012 :

Hello, I discussed this with you and read your scan to you over the weekend. Do you want to discuss this with another neurologist? Let me know and I will opt-out of this discussion , no problem. If you want to discuss further with me, just replay to this posting, Dr. Frank T (neuromd2012)

neuromd2012 :
neuromd2012 :

HI


 

neuromd2012 :

are you there


 

neuromd2012 :

You have attached some more pictures, this is a beautiful study and clearly shows the thrombosis


 

Customer: Hi, no its fine...i e-mailed the neurologist i am due to see on wednesday, just to tell him my thoughts on the subject. He hasn't replied yet, and i rang his secretary but she just said wait for him to call me.
neuromd2012 :

absolutely, I do not understand the problem here, this is a radiologic diagnosis, is there a neuroradiologist involved?

neuromd2012 :

he just needs to sit at his desk for five minutes


 

neuromd2012 :

can you hang on for a bit, I want to research the treatment for your condition, when were you on the train?


 

Customer: I'm really sorry, but i'm sure you can understand that these past 5 months have made me very sceptical of what i'm being told. Please dont be insulted - are u seriously a real doctor??
neuromd2012 :

I am a neurologist with the most famous and respected medical institution here in the United States, it is called the national institute of health, and it is the federal health agency


 

neuromd2012 :

I am an expert in experimental neuroradiology, using equipment that is not available in the rest of the world.


 

Customer: To be honest, i'm sure you can tell i'm not stupid...even without your testimony, i am certain it is thrombosis too!
neuromd2012 :

I use a 4.7 Tesla MRI scanner and a experimental PET scanner to do things that cannot be done anywhere else


 

neuromd2012 :

I will send you a webpage, hold on


 

neuromd2012 :

http://www.nih.gov/


 

neuromd2012 :

I understand that you have no reason to believe me, but I am telling you that you have a thrombosis and that is what you have


 

Customer: Ok, i'm sorry, but the "doctors" i've been seeing recently have tainted my view of medical professionals. These 'bad eggs' give people like you a bad name.
neuromd2012 :

I understand, what is the name of the radiology office where you went, In the US , they are required to have certified neuroradiologist reading all of their brain scans


 

neuromd2012 :

because they can be sued if they say something wrong or miss something


 

neuromd2012 :

I cannot believe this story, it is unbelievable that this would happen in this country


 

Customer: I don't understand how this hasn't hasn't been picked up sooner, i've almost diagnosed myself really! Should i be pissed off, how serious is this?
neuromd2012 :

How long has it been since your were on that train

neuromd2012 :

you should be very very piissed off, they have really messed up, can you get a lawyer and sue them?


 

Customer: I paid privately in the end, the neurologist is called Professer Patrick Chinnery, at The Nuffield Hospital, in Newcastle UK.
neuromd2012 :

do you want me to contact him directly?

Customer: I had an appointment with him last wednesday, and he said he would call asap as i am supposed to be emmigrating to Australis in June.
neuromd2012 :

take your films to any good neurologist, this is a "no brainer" as we say in medicine, any qualified neurologist can see this problem on an MRI scan


 

Customer: If you would do that i would be so grateful....honestly, i feel like your the only one who has listened to my concerns at all!
neuromd2012 :

hang on for a minute ok?


 

Customer: Yea, to be honest, i feel that a child would spot that abnormality and say "what is that white smudge?"
neuromd2012 :

I tried to call him, but I cannot get through here from New York. I can send him an email, what is your name?


 

Customer: I mean i have no medical background, i'm a business student, but as soon as i seen those slides i wondered why is it not symmetrical?
neuromd2012 :

what is your name?


 

Customer: XXXXX XXXXXon
neuromd2012 :

ok I will send him an email, hang on


 

Customer: If i go offline, i have to go pick my Mam up from work....can you wait and speak to her because i showed her the images and i dont think she is convinced either. I think everybody thinks i'm being paranoid, but in my own head i know i'm being to laid back!
neuromd2012 :

I sent him an email

neuromd2012 :

I gave him your name and your story and told him to investigate it and contact you today


 

Customer: Also, your totally right, is should have trusted my gut feeling and kicked up more of a fuss early on.
Customer: Would and ENT have been able spot this?
neuromd2012 :

as I said before, you have to wait for this clot to dissolve now, there is no treatment I believe,


 

neuromd2012 :

no this is neurology


 

neuromd2012 :

neurosurgery


 

neuromd2012 :

again, when were you on that train, there are some people that do surgery to remove the clot, would you consider that?


 

Customer: I'm glad you feel i should take legal action, because i do too in all honesty.
neuromd2012 :

can you hit the accept button if you are satisfied


 

Customer: I was on the train....erm, around the 9th of december last year. Then everything went downhill from there
neuromd2012 :

I think you should consider it here, I know in the US there would be no question, but I don't know england


 

neuromd2012 :

you don't want surgery now


 

neuromd2012 :

the clot is fully lysed by now I think but you should find a neurosurgical expert in venous thrombosis to ask that question in england


 

neuromd2012 :
Customer: Ok
Customer: I couldn't afford to come to the states, my mam is a single parent, and all my savings are to pay for a new house in Australia.
neuromd2012 :

do you have any more questions? keep in touch with me because I am so interested to find out the outcome. Well I dont


 

Customer: If i do take legal action, are you able to vouch for me....at the very least i'm going to complain!
neuromd2012 :

want to write the obvious here , for legal reasons, but you should look into this situation if you were ignored with these symptoms, honestly


 

neuromd2012 :

well I only know you over the internet, so anything you say I have to take as the truth. I never examined you and cannot substantiate your clinical complaints


 

neuromd2012 :

but you should see another neurologist there or better an neurophthalmologist to document your eye findings, he will test how your eyes move to vestibular testing


 

neuromd2012 :

and get the films to a lawyer


 

Customer: Yea, i suppose you're right. My sister is a Law Undergraduate, i can get her on the case haha
neuromd2012 :

good luck to you, how am I going to contact you if your neurologist sends me an email?


 

Customer: Can i put my e-mail address on here?
neuromd2012 :

no they will put xxx around it, you need to come back later and log in ok?


 

neuromd2012 :

lI recieved a receipt in my email box so he did get my email


 

Customer: Yea definately, im will try and call him again and come back on here in a couple of hours....
Customer: Again, i can't thank you enough!!
neuromd2012 :

great see you


 

Customer:

is your name Frank Telang?

Customer:

hey are you there?

Customer:

are u there?

neuromd2012 :

hi


 

neuromd2012 :

are you there?


 

Customer:

yea

neuromd2012 :

I didn't get a call back.


 

neuromd2012 :

please don't use a name here as that is against the rules,


 

Customer:

is that you though?

neuromd2012 :

cannot say

Customer:

i honestly dont care if it is, just as long as you have told me the truth that you are/once were a real doctor and know what you are talking about!

neuromd2012 :

I am a doctor, I work in the US, nothing not true there


 

neuromd2012 :

do you have any questions?


 

Customer:

if you are frank telang of Long Island, NY. dont sign your posts Frank T. and put a real pic up there <---------

Customer:

thats not very bright is it!!

Customer:

but if you really are frank telang then ive read some of your papers and know you are/once were a doctor

Customer:

so i wont judge, i just want your help

neuromd2012 :

I don't have a need to hide my identitiy. It is the policy of this place to keep the doctors anonymous. I am a real doctor, I have a current medical license and a practice. why are you hassling me and ruining my chance to stay with this company. Shut you F444 mouth

Expert:  Dr. Frank replied 2 years ago.
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Customer: replied 2 years ago.
how can what i'm saying ruin your chance with this company?? unless what i am saying is true? anyway, like i said i dont give a toss anyway, i just want some answers, and you've given me some so thanks.
Expert:  Dr. Frank replied 2 years ago.
we are not suppose to give out personal information, it is part of the rules, and I have not given out my personal information. I did, however, stick my head into the chance that you could identify me by contacting your physician directly. that is also against the rules and violates policy. But I did it because you have a bad problem and it seems, from what you told me, at least what you said, that no one is taking you seriously. I did this for you. that has always been my problem I should treat all patients like they are worthless. like most doctors. stop pursuing this line of questioning on this website.
Customer: replied 2 years ago.
ok, im sorry...you have helped me more than anybody else anyway!! it makes no difference to me who u are in all honesty...it seems like we both just want to get to the bottom of this!!

I've feel as if i've been lied to (or at least talking to people who think they know what they are talking about) so much that i'm really on the defensive now!!

thank you for e-mailing Professor Chinnery...sincerely...has he e-mailed back??

I've rang at least 10 times, and i cant even get hold of his secretary!!
Expert:  Dr. Frank replied 2 years ago.
no reply from your neurologist. You should take your films to someone else, have you shown these to another neurologist?????? on a neurosurgeon, you actually need an invasive neuroradiologist to tell you options. try that approach. Dr. Frank T.
Customer: replied 2 years ago.
no not to any other neurologists aside from you. Do you know any invasive neuro-radiologists in the UK that i can e-mail?? What if this Professor Patrick Chinnery comes back to me and says it isnt thrombosis - when it clearly is??
Expert:  Dr. Frank replied 2 years ago.

Send your pictures to this doctor, DR.JH Gillard. he does atheroma research and investigational neuroradiology. He runs the grad fellow program and will hopefully look at your pictures and give you an answer. ok? let me know.

http://www.medschl.cam.ac.uk/radiology/University%20Staff/gillard.html

Customer: replied 2 years ago.
Hey, i e-mailed Dr. Gillard and told him the whole story as concisely as possible, i sent him the images i sent you. Do you know him personally or just familiar with his work?? Itnsays he studied in the US. I feel like my head is going to explode, how can it take so long to just call me or send an e-mail and give me an answer? There's a big debate over here whether to privatise our National Health Service at the minute, i say sooner the better. I didnt realise how bad we have it over here!
Expert:  Dr. Frank replied 2 years ago.
Isn't it like midnight over there? Is he still working or asleep? I don't know him a bit, but you wanted a fellow countryman, and so it looks like he might be someone that could tell you, although I couldn't tell if he was an MD/PhD or a PhD, in which case he probably won't read them.. I think he is an MD
Customer: replied 2 years ago.
Hey, i have just been called to the hospital that performed my MRI scan...they think that maybe it is thrombosis, although said that it could be an artifact on the images???

I am due to go for a private MR Venogram on Thursday morning, which they said will be more precise. They said i dont have to pay, which gives me the feeling that they know somebody has made a mistake??

Professor Patrick Chinnery has not got back to me yet!! I know why we were unable to reach him by phone - his private secretary is on annual leave.
Expert:  Dr. Frank replied 2 years ago.

Sounds like they are coming around to their senses. I don't know how it works in England, but here they would be bending over backward from fear of the legal summons to court. There is no question that an MR Venogram is the better study for this problem, they will be able to measure the thrombus better, in relation to the lumen of the sinus,the key now is that you do not want the thrombus to propagate or break into pieces.

good luck to you, please get back to me with the venogram if you can. I am here for you. Dr. Frank T.

Customer: replied 2 years ago.
yea, no question, i will let you look at them for sure. i will keep you informed...still no reply from Professor Chinnery, this is like a comedy of errors!!
Expert:  Dr. Frank replied 2 years ago.
great. Could you please hit the accept button if you feel I answered your question as I have to move on to another question, you can still come back later then to give me the images. thank you. XXXXX t.
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 7201
Experience: Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
Dr. Frank and other Neurology Specialists are ready to help you
Customer: replied 2 years ago.
i've just been on the phone to John Carmichael the Radiology Manager at the place that is doing my Venogram. He said that he thinks it is thrombosis, but that it would have been very hard to spot and that it is not as "clear-cut" as you say. I thought medicine was a science?? Appears to me tht it is more of an Artform!! Surely this is a "black or white" case so to speak??
Expert:  Dr. Frank replied 2 years ago.
Sorry John Carmichael, the Radiology Manager, should stick to his sausages and whatever you guys eat over there (what do you call that stuff?) That is clearly an insane statement, you could teach a monkey to see that. they are trying to CYA as they say in this country (cover you A**). Did Dr. Gillard get back to you? let me know, what a joke!
Customer: replied 2 years ago.
haha sausages and mash!! i actually think he is one of the good ones, but yea, it sounded like people are spooked and they are trying to dumb me down. He said that because it is an FGRE scan or something, those ones are just used for initial investigations and not for diagnosis. My answer to that was "well, why does that particular part of my right sigmoid sinus/IJV look irregular on all the other types of scan too?
Expert:  Dr. Frank replied 2 years ago.
don't know what you mean by FGRE scan, they may have different scan sequence names. I was at at MRI meeting in scotland (ISMRM meeting) and I never heard that term....anyway, get back to me, a very interesting case take care
Customer: replied 2 years ago.
Hi, i am going to see a vascular surgeon today, his name is Mr Philip Davey at the Woodlands Hospital. It's a big ask, but could you possibly e-mail him for me and tell him your thoughts??

http://www.vascular-endovascular.co.uk/philip-davey.html

Are there any questions i need to be asking him in particular?? Irregardless of whether i need surgery or not, should i not at least be on anti-coagulants?
Expert:  Dr. Frank replied 2 years ago.
HI. In the US, this type of vascular surgeon would probably not get involved in this problem, but he can give you information in terms of removal of the lysed clot and/or anticoagulation. I sent him an email telling him that I had met you online, and had not examened you, but that the images you sent suggested the thrombosis. I am sure he will not have a problem identifying the MRI changes. Good Luck to you. I did not get a response from your original neurologist. Dr. Frank T.
Customer: replied 2 years ago.
Hi, thanks for e-mailing Mr. Davey. You'll be glad to hear i went to see my neurologist, Professor Chinnery. I arrived unannounced and demanded to see him (think i should have been this forceful from the beginning!!) He said he got your e-mail, but was very sceptical. He said that you are just telling me what i want to hear.

He also received my e-mail but said he didnt reply because it wasn't very"secure", and isn't "correct procedure" which i suppose is fair enough. I asked him why he hadn't called me within a week, to which he replied he "couldn't remember" saying he would call within a week, but he did apologise and also apologised for his secretary being on holiday. So still waiting for a neurological report from him.....

My MRV is tomorrow at 8am. As soon as i get back i will upload some of the images from it. Is there no way i can find out your e-mail address so i can send you all of my original MRI images plus the whatever images are produced from my MRV tomorrow?
Expert:  Dr. Frank replied 2 years ago.
HI I really cant break the rules as I have signed a contract. but you can upload them here and I will be around to give you my imput, so don't worry. Did Dr. Chinnery say he looked at the MRI? I was quite straight with him and mentioned that I had never met you , never examined you, but that the MRI was self-explanatory. The MRV will help tommorrow, let me know and good luck. Dr. Frank T.
Customer: replied 2 years ago.
He didn't say whether he had looked at my actual images, but he received my e-mail so he has definitely seen the exact same images you have, as i sent him the same screen shots as i did you.

Yea, hopefully tomorrow will clear a few things up.
Expert:  Dr. Frank replied 2 years ago.

great

Customer: replied 2 years ago.
Hi, just got back from my MRV...why does nobody talk to you after these scans and just say "yes, you're ok to book your flights to Aus" or "just hold out for a while"??

Now that we are chatting like this it won't let me upload any images, is there any way we can go back to the web chat format just so i can send u the pics?
Customer: replied 2 years ago.
Hi, i had a brain wave...i now have a Flickr account, i've put 65 images on there - quite alot i know but i don't really know which are more useful, so my thinking was the more you could interpret the better.

The link to the photos is:

http://www.flickr.com/photos/78754882@N07/

Let me know if that doesn't work as i'm new to this website. I think you can comment on individual images too!!

Also, the radiologist told me that now i have had these new images done, i now need to destroy the old images. They letters C.Y.A. sprang to mind, but maybe i'm just being cynical??
Customer: replied 2 years ago.
...and again, you have given me so much of your time...being at risk of sounding like a broken record...Thanks you very much again!!
Expert:  Dr. Frank replied 2 years ago.
William, this is a very nice study. You should get their imput as they know the delay times and the images better. I am not an expert in MR venography, but I think this shows bilateral draining into the confluens of the sinuses, the transverse on the left seems a bit smaller than the right, but both are present and draining, ( and you can have assymetry of the sinuses) the sigmoid on the left is also smaller but draining, I cannot see the left internal jugular draining still, and there seems to be some collateral draining veins on that side. I thought the initial films showed the right jugular/sigmoid involved so this could be the resolution of this problem we are seeing, or maybe it was artifact on the original scan.(do you know if they used a surface coil when they did the original scan?). Let me know what they say.
Customer: replied 2 years ago.
What do you mean by delay times?? Is it likely i will be able to fly to Australia in June?? No worries if your unable to answer these questions, i understand you can't be sure based on just the images i have sent.

When i go back to hospital i will make sure they explain it all to me and make sure i get a copy of the report. I don't know if they used a surface coil when the did the original scan but i can find out and get back to you.
Expert:  Dr. Frank replied 2 years ago.
By delay times, there is a pulse generated and then the sequence collects data for processing a certain times after the pulse, so you can "follow" the activation signal or the white blood through the veins, the delay times are key as to where you should look when (if you know what I mean). so again, like every test, you can have variable results if you misinterpret. For example, if they were using a surface coil to generate the RF and that coil was along your right side on the original scan, it can generate coil artifacts, we don't do that here for that study, but everyone does things differently.
Customer: replied 2 years ago.
Ok, i sort of get what you mean. In your opinion, again just from the images, would you say that i have: a) had some sort of thrombosis which has somewhat resolved itself, b) still have thrombosis or c) have never had thrombosis?? (bit like who wants to be a millionaire)

Customer: replied 2 years ago.
Hi, this never seems to end...now i'm really confused. Just had a phone call saying that i have the 'all clear'. They said that my LEFT sigmoid/IJV looks slightly hypoplastic?? which apparently is normal for some people, and that their is no sign od thrombus in the LEFT sigmoid/IJV????

what the hell is going on?? can these people not tell left from right now? the right sinus has been the focus of attention, why have they not even mentioned it?
Customer: replied 2 years ago.
while trawling the net i found this...

http://en.wikipedia.org/wiki/Lemierre's_syndrome
Expert:  Dr. Frank replied 2 years ago.
Hi. the piece on Lemierres is interesting but you would have been very sick and I assume you have never had an episode of a pulmonary embolism, septic or not septic. As I mentioned you have some assymetry with the left side being hypoplastic, but that is a normal variant. I am glad that they see the draining of the left side, which I could not see. I am starting to think the right side was artifactual, the only problem with that is that you were symptomatic at the time, so something was going on in that right jugular/ sigmoid area, that was december. I would not expect a clot to fully lyse and resolve without any scarring or adhesions, so I am at a loss here. But the good news is that you can go off to Australia on your trip. good luck william

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