Possible Problems



carotid doppler


A test called the carotid ultrasound can detect the buildup of cholesterol-filled plaque in the carotid arteries in the neck. These arteries deliver blood to the brain. The test, which uses sound waves, is quick, safe, and without any immediate potential for harm. It makes perfect
sense for someone experiencing lightheadedness, memory loss, or the warning signs of a stroke or mini-stroke.

Having a carotid ultrasound test also makes sense for anyone in whom a doctor hears an abnormal sound called a bruit (BREW-ee) as he or she listens to the carotid arteries through a stethoscope. The scan is also a reasonable idea when a person has known risk factors for stroke, such as a previous “mini-stroke,” high blood pressure, high cholesterol, or diabetes. But a carotid ultrasound isn’t a good idea for otherwise healthy people at average risk for stroke.

Excerpt from the Harvard Medical School's Healthbeat

To read about more tests:




I have found & I so teach my students that the US Preventive Taskforce is gospel & should be listened to at all costs!!

Bertrand M. Bell MD
Professor of Medicine
Albert Einstein College of Medicine



Comments from our members:

1. People wanted to know the results of the carotid artery doppler ultrasound that was done. Here are the result passed to me by my PCP:Carotid artery Ultrasound report: Right side - cholesterol accumulation which results in 30-50% blockage. Left - 0-39%. You can see that this is inexact. But, sort of confirms our suspicion about your symptoms. This degree of blockage doesn't usually require surgery, etc. However, in light of your prior surgeries, I'd like to hear an opinion from a vascular surgeon.

I wrote back to my doctor in response: Thanks for the report. I wonder how they can tell the difference between cholesterol accumulation and radiation or surgical scarring using and

The doctor responded:They probably can't. And I agree / suspect the latter. We'll work on an
appointment for you.

So, it would seem that we are still an enigma to the medicatl community. My surgeon, whom I work with as a volunteer, commented that the results are pretty good for any senior, laryngectomee or not. All good news is always welcome. :)


2. I was told the Carotid CT scan does a much better job of identifying the nature of the blockage.

3. In checkup year before last, my doc heard something he wanted to check out. I came back for the carotid doppler. Very easy and simple. Takes a little while because the tech moves slowly and watches the screen. My blockage wasn't enough to cause problems... Had it done again this year and the doc thought it was doing great... but said, if it reaches a certain percentage of blockage, he would send me to have it cleaned out. Right now it is well under a figure to be concerned about.


4. I have had this test done twice and it is nothing at all to worry about...like an echo gram to your neck...about 20 minutes or so. They found my right side blocked at 65% and said that was fine for my age and all. As I understand it they don't want to do anything intrusive unless you're 85% or more and then they prefer meds first. I had similar symptoms to yours and they have been gone for 8 years since I started taking a baby (91mg) aspirin each morning. I take a coat one that dissolves in the intestines not the stomach. Best of health to you all.


5. It's a very simple test that takes about 45 minutes as the tech will check both sides of the neck. I've had at least 20 of these test over the last 20 years and my carotids are pretty good but several years ago I had a small blood vessel burst at the stem of the neck and the bleeding down on the spinal cord caused the lost of some motor skills, was hospitalized for 3-4 days and when the bleeding stopped the problem went away and no problem since. The neurologist blamed to radiation for weakening the blood vessel. There are fixes but I don't have the knowledge to comment on them.



Stroke and vascular Problems Related to Head and Neck Radiation



A number of our members have complained about blackouts. One would get up, walk across the room and wake up on the floor. Dr. Peters wrote an article about this possibility for HeadLines that I'll print below, but you can now find a lot of information on the Internet (see below). Perhaps you could talk with your doctor about your blood pressure and this possibility. (NOTE: you must keep yourself well hydrated.)

Doctor, can radiation cause dizzy or fainting spells (vasovagal syncope)?


Let's start by reviewing some anatomy. Then, I will address the problem some patients have when they turn their heads and get a little dizzy and light headed. On either side of your neck is the carotid arteries which are the main suppliers of blood to the head and more specifically, the brain. This artery comes into the neck from the chest as a single large artery, the common carotid artery, then splits in the upper neck to become the external carotid artery supplying blood to the face and head outside of the skull and the internal carotid artery supplying blood to the brain. Where this artery splits is called the carotid bulb and you can usually feel it as a pulsating mass in the upper neck. The carotid artery and especially the carotid bulb are enervated by some specialized nerve fibers that are sensitive to the chemical content of the blood and also to the pressure of the blood inside of them.


Now, lets say you have had surgery on the neck or radiation to neck. Remember that either of these can cause some degree of scarring around this blood vessel resulting in some degree of "squeeze" on them. The nerves, that I mentioned above, read this as an increase in the pressure INSIDE of them and set in motion automatic measures to lower the blood pressure. These include a lowering of the heart rate and a dilatation of the blood vessels in the rest of the body. The net result of all of this is a relative lowering of the blood pressure to the brain and the sense of dizziness and being light headed. This whole thing can be made even worse if you have some degree of athersclerosis (cholesterol plaque)or if you are taking medicines for high blood pressure. Dehydration also may be a contributing factor.


If you have this problem, unfortunately there is not much that can be done to eliminate it. The most important thing is to simply be aware that the problem exists and not change positions rapidly, i.e. lying to sitting or sitting to standing. Take your time when you get up and don't immediately start walking. You might want to make sure you are well hydrated and that your blood pressure is under good control and your anti-hypertensive medicine is right for you. If the problem is severe enough that you almost black out or if it occurs very frequently, please check with your doctor and make sure that you are not having transient ischemic attacks (mini strokes) or something wrong with the heart itself causing it to be an inefficient pump.


Glenn E. Peters M.D.
Director, Division of Otolaryngology - Head and Neck Surgery
University of Alabama at Birmingham, Birmingham, Alabama, USA


There are many pages of information about fainting with sections written on these areas:

Introduction to fainting (syncope)
What causes fainting (syncope)?
Heart rhythm changes
Heart structural conditions
Heart valve conditions
Sudden cardiac death
Postural hypotension
Vasovagal syncope
Orthostatic hypotension
Vertebrobasilar system
Electrolyte imbalance
Other medications and drugs
What are the signs and symptoms of fainting (syncope)?
How is fainting (syncope) diagnosed?
What is the treatment for fainting (syncope)?
Can fainting (syncope) be prevented?
Fainting (Syncope) At A Glance
Patient Discussions: Fainting - Describe Your Experience




Vasovagal Syncope, Low Blood Pressure Syncope and Vertigo

These are not the same thing, nor do they have the same causative factors but they all cause types of dizziness.



Vasovagal syncope (vay-zo-VAY-gul SING-cuh-pee) is the most common cause of fainting. Vasovagal syncope occurs when your body overreacts to triggers, such as the sight of blood or extreme emotional distress. The trigger results in vasovagal syncope — a brief loss of consciousness caused by a sudden drop in your heart rate and blood pressure, which reduces blood flow to your brain.

Vasovagal syncope is usually harmless and requires no treatment. However, you can injure yourself during a vasovagal syncope episode. Also, your doctor may recommend tests to rule out more serious causes of fainting, such as heart disorders.

Before a faint due to vasovagal syncope, you may experience some of the following:
• Skin paleness
• Lightheadedness
• Tunnel vision — your field of vision is constricted so that you see only what's in front of you
• Nausea
• Feeling of warmth
• A cold, clammy sweat
Common triggers for vasovagal syncope include:
• Standing for long periods of time
• Heat exposure
• The sight of blood
• Having blood drawn
• Fear of bodily injury
• Straining, such as to have a bowel movement

In most cases of vasovagal syncope, treatment is unnecessary. Your doctor may help you identify your fainting triggers and discuss ways you can avoid them. However, if you experience vasovagal syncope often enough to interfere with your quality of life, your doctor may suggest trying one or more of the following remedies.

Drugs that might help prevent vasovagal syncope include:
• Blood pressure drugs. Beta blockers such as metoprolol (Lopressor) are designed to treat high blood pressure. They are also the type of drug used most often to prevent vasovagal syncope because they block some of the signals that can lead to fainting.
• Antidepressants. Selective serotonin reuptake inhibitors, such as paroxetine (Paxil), fluoxetine (Prozac) and sertraline (Zoloft), also have been successful in preventing vasovagal syncope.
• Blood vessel constrictors. Drugs to treat low blood pressure or asthma are sometimes helpful in preventing vasovagal syncope.
Your doctor may recommend specific techniques to decrease the pooling of blood in your legs. These may include foot exercises, wearing elastic stockings or tensing your leg muscles when standing and increasing salt in your diet if you don't have high blood pressure. Avoid prolonged standing — especially in hot, crowded places — and drink plenty of fluids



For some people, low blood pressure can signal an underlying problem, especially when it drops suddenly or is accompanied by signs and symptoms such as:
• Dizziness or lightheadedness
• Fainting (syncope)
• Lack of concentration
• Blurred vision
• Nausea
• Cold, clammy, pale skin
• Rapid, shallow breathing
• Fatigue
• Depression
• Thirst
When to see a doctor
In many instances, low blood pressure isn't serious. If you have consistently low readings but feel fine, your doctor is likely to monitor you during routine exams. Even occasional dizziness or lightheadedness may be a relatively minor problem — the result of mild dehydration from too much time in the sun or a hot tub, for example. In these situations, it's not a matter so much of how far, but of how quickly, your blood pressure drops.

Depending on the reason for your low blood pressure, you may be able to take certain steps to help reduce or even prevent symptoms. Some suggestions include:

• Drink more water, less alcohol. Alcohol is dehydrating and can lower blood pressure, even if you drink in moderation.
• Follow a healthy diet.
• Go slowly when changing body positions. You may be able to reduce the dizziness and lightheadedness that occur with low blood pressure on standing by taking it easy when you move from a prone to a standing position. Before getting out of bed in the morning, breathe deeply for a few minutes and then slowly sit up before standing. Sleeping with the head of your bed slightly elevated also can help fight the effects of gravity. If you begin to get symptoms while standing, cross your thighs in a scissors fashion and squeeze, or put one foot on a ledge or chair and lean as far forward as possible. These maneuvers encourage blood to flow from your legs to your heart.
• Eat small, low-carb meals.

I'll add another that I read about... Raise the head of your bed and sleep on a slant if you hve low blood pressure in the mornings. .. Many of us do this anyway for acid refux avoidance!!



Dizziness can range from a fleeting, momentary sensation to a severe loss of balance disorder that makes normal functioning impossible. Nearly half of all adults will have an episode of dizziness serious enough to send them to the doctor.

Dizziness generally refers to three specific sensations:

• Faintness. One type of dizziness is described as feeling lightheaded, as if you might pass out.
• Loss of balance. Another type of dizziness is characterized by feeling unsteady on your feet, as if you might fall.
• Vertigo. With vertigo, you feel as if the world is spinning around you or that you yourself are spinning.
Describing your dizziness as precisely as possible will make it easier for your doctor to diagnose the cause and treat it.

The causes of dizziness are as varied as its symptoms. Dizziness can result from something as simple as motion sickness — the queasy feeling that you get on hairpin roads and roller coasters. Or it can be caused by complicated problems with the balance mechanism in your inner ear.

Inner ear problems
Many cases of dizziness are caused by problems that affect the balance mechanism in your inner ear. Examples include:
• Benign paroxysmal positional vertigo (BPPV)
• Ear infection (middle ear)
• Meniere's disease
• Motion sickness: First aid
Reduced blood flow
Dizziness can be caused if your brain doesn't receive enough blood. This can occur for a variety of reasons, including:
• Arteriosclerosis / atherosclerosis
• Dehydration
• Heart arrhythmias
• Orthostatic hypotension (postural hypotension)
• Stroke
• Transient ischemic attack (TIA)

There are more listed but not as common.



Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that you're spinning or that the inside of your head is spinning.

Benign paroxysmal positional vertigo is characterized by brief episodes of mild to intense dizziness. Symptoms of benign paroxysmal positional vertigo are triggered by specific changes in the position of your head, such as tipping your head up or down, and by lying down, turning over or sitting up in bed. You may also feel out of balance when standing or walking.

Although benign paroxysmal positional vertigo can be a bothersome problem, it's rarely serious except when it increases the chance of falls. You can receive effective treatment for benign paroxysmal positional vertigo during a doctor's office visit.

The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:
A sense that you or your surroundings are spinning or moving (vertigo)
A loss of balance
Blurred vision associated with the sensation of vertigo


For suggestions, contributions, corrections or questions about this section, please contact:

Library Staff



© Registrar.eu 2019