Dissected Internal Carotid Artery and Coumadin??

[Matt]

All,

Background Info:
1) 26 year old male (Java Programmer)
2) Very outgoing and athletic
3) Have ADHD and General Anxiety Disorder
4) Currently taking Wellbutrin and Adderall for ADHD
5) Taking Soma pills to relieve back pains at night

For about six months this year, I had been going to see a Chiropractor for back problems. At the end of August, the Chiropractor made a neck adjustment on me causing my left Internal Carotid Artery to be dissected. After a week of hospitalization, I was sent home and to begin taking Warfarin so as to assist in curing the dissection. Note that the Doctors had done an MRI on my brain, neck, and back as well as a CT Angiogram on my neck and brain. The neurointerventional surgeon advised me that I'm on thin ice and need to take it very easy for the next few months and then fairly easy after that until March 2010. I was advised that all it takes is one clot to my brain and I'm a goner or paralyzed on the right side of my body for the rest of my life (scary stuff)! The surgeon advised me that I need to do an angiogram (via a catheter); however, he warned me that there are risks involved (the dye shot into my artery could dislodge part of a clot near the dissection in my ICA causing it to go straight to my brain).

After several weeks, my Doctor finally got my INR level within a stable range, between 2.0 and 3.0 (8mg on Sunday and Wednesday & 6mg every other day). Over the course of the last two months, I've been to the ER room twice due to light-headedness, numbness on the right side of my body, strange tingly feeling in brain, disorientation/equilibrium was off, dehydrated, and fatigued (some stroke-like symptoms). Note that I've also felt these symptoms at other times as well; however, I've simply tried to ignore them. I've come to realize that the only thing keeping me alive is the Warfarin.

Each time I was in the ER, the Doctors were unable to find any issues (after a CT Neck Angiogram the last time), other than the fact that I'm simply tired, dehydrated, and/or stressed out. Also, it appears that because the Doctors have put the "Fear of God" in me about stroke symptoms, my body has automatically trained itself to go into a state of shock if and when something happens to the right side of my body. From this point, I have been trying to discern as to if these symptoms are simply transpiring due to shock (across the body) and/or the Coumadin/Warfarin.

I spoke with my Doctors about this a few weeks ago and was advised that Coumadin has little to no side effects other than heavy bleeding or bruising if injured. If I began experiencing any of the stroke (FAST) symptoms, I was to immediately get myself to the Emergency Room. I discovered several websites that state that Coumadin can cause stroke-like symptoms and that it can also cause fatigue and dehydration.

All I can figure at this point is that the side effects I've been experiencing over the last 2 months can only be caused due to shock (psychological), my medications, or a combination of both.

Other Info:
1) I've been walking about 10 minutes per day and trying to increase by a minute per week. Hopefully by March of 2010, I will be able to jog again.

A) I've been forced to avoid any physical activity that could dislodge a piece of the clot in my artery.

2) The past two months have been the craziest in my entire life.

3) I work about 40 - 50 hours per week at a Tech firm here in Austin.

4) Before the injury, I was jogging about 3 miles every day on a treadmill.

Has anyone else experienced similar side effects from the Warfarin/Coumadin (i.e. stroke-like symptoms, fatigue, dehydration)?

Any help would be appreciated!

Thanks,
Matt

[Jules]

Hi Matt, I was just diagnosed last week with bilateral (both sides) carotid dissections since having symproms after a thyroidectomy 3 weeks ago, and landing in the ER. Sorry I can't offer any advice as I am just starting down this road. However, I wish you lots of luck, knowing first-hand how terrifying this is. I am not yet therapeutic (INR 2-3) and jumped from 1.8 to 4.2 since Tuesday. I have some of the symptoms you describe and think it's part of the carotid problem, not the coumadin, since I had them before I was diagnosed. Take care.

[Matt]

Jules wrote:

Hi Matt, I was just diagnosed last week with bilateral (both sides) carotid dissections since having symproms after a thyroidectomy 3 weeks ago, and landing in the ER. Sorry I can't offer any advice as I am just starting down this road. However, I wish you lots of luck, knowing first-hand how terrifying this is. I am not yet therapeutic (INR 2-3) and jumped from 1.8 to 4.2 since Tuesday. I have some of the symptoms you describe and think it's part of the carotid problem, not the coumadin, since I had them before I was diagnosed. Take care.

Jules - Thanks for the input!

Wow!- I wish you the best as well! Curious - Were the dissections complete within the arteries (full closure)? I don't understand how you're brain can still function on two arteries alone (*That's awesome news!).

Also - If it helps anyone, I found that my INR level was below a 2.0 (fluctuating from a 1.6 to 1.9) which happened to be causing me to have Stroke-like symptoms. I chewed my Doctor out and had him MAKE SURE that my INR is at least a 2.3 or 2.4. If only I could afford one of those coagulant checker devices, life would be so much easier.

[Jules]

Matt wrote:

<quoted text>
Jules - Thanks for the input!
Wow!- I wish you the best as well! Curious - Were the dissections complete within the arteries (full closure)? I don't understand how you're brain can still function on two arteries alone (*That's awesome news!).

Matt, my right carotid was 100% blocked and the left 90-99% blocked, so yes, the dissections were complete.

The surprise (and small relief to hear!) was that there are two more arteries in the back of the head that bring blood to the brain independently of the carotids, called vertebral arteries. It was explained to me that there is "blood flow redundancy" and that those arteries simply take over the work of the carotids.

I saw a top neurosurgeon today for a second opinion who told me he had a patient who dissected all four arteries and survived -- now that's REALLY scary!

My right artery is now only 80% blocked and the left 50%- I had another CT on the weekend which shows healing is taking place.

PS: I still have not balanced my Coumadin and am either too low (1.7) or too high (3 to 4.2). I have not yet been between 2 and 3.:(