
Dorothea Altschul MD FAHA FSVIN
@DrAltschul
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🏆 Award-Winning Brain Doctor 🧠 Blood Flow Expert | 16+ in Practice 🏥 Director of Neuroendovascular Surgery | Views = mine https://t.co/eWbj9Ve3n4
New York, NY
Joined February 2019
“I woke up and the noise was gone.” My patient suffered from pulsatile tinnitus — that relentless whooshing sound in sync with her heartbeat. We found the cause. We treated it. Now: silence. Pulsatile tinnitus is real. And yes—it’s treatable. #PulsatileTinnitus #BrainFlow
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Sink or swim! Brain is swimming in CSF! CSF is key for protection, buoyancy, & hormone/waste transport Most know basic ventricular anatomy well, but not subarachnoid anatomy. How many cisterns do YOU know? Here’s a quick guide to the key midline cisterns & what to know for
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Does the straight sinus play a role in patients with cerebral venous outflow disorders? Fargen et al report a series of 51 patients in whom the straight sinus was successfully catheterized in 38 patients. They found a mean straight sinus pressure gradient of 2.6mmHg with 30.6%
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The IJV isn’t just a passive drain. It’s a dynamic pathway that can influence brain health. If symptoms are unexplained, venous outflow should be on the differential.
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Diagnostics: •Duplex ultrasound (dynamic flow) •MR/CT venography •Catheter venography with manometry (gold standard for pressure assessment)
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Why it matters clinically: Narrowing or obstruction can lead to: •Headaches •Pulsatile tinnitus •Visual disturbances •Cognitive changes •Fatigue
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Why it matters clinically: Narrowing or obstruction can lead to: •Headaches •Pulsatile tinnitus •Visual disturbances •Cognitive changes •Fatigue
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Drains blood from the brain, face, and neck •Returns it to the heart for reoxygenation •Plays a key role in regulating intracranial pressure and serves as access point
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•Originates at the jugular foramen (base of skull) •Runs down the neck inside the carotid sheath, alongside the carotid artery + vagus nerve •Joins the subclavian vein to form the brachiocephalic → SVC → heart
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Arteries get the glory. But the brain’s quiet river — the internal jugular vein — can change everything. 💙🧠 Here’s why it deserves your attention. A🧵
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90+% of patients we see with infratentorial superficial siderosis have an underlying spinal CSF leak. This week we saw two other causes: a IVth ventricular ependymoma (postop dural thickening from overdraining shunt) and bilateral jugular vein occlusion @LivingwithSS
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Your brain has a built-in rinse cycle. It’s called cerebrospinal fluid (#CSF) and it clears toxins with every heartbeat & breath. When it slows, waste builds up → brain fog, memory loss, dementia risk. Breathe deeper. Move daily. Protect the flow. #BrainFog #InvestInYourBrain
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Cognitive dysfunction—mainly in executive function, speed & attention—is seen in up to 86% of cerebral venous congestion cases.” Yet we still use the wrong tests. MoCA & MMSE miss it. It’s time to do better. 📖 @Ferdinandhui et al. @JNIS_BMJ 2025 #InvestInYourBrain #IIH
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The brain forgets how to flow… long before it forgets your name. Shrinkage starts silently. I listen to your symptoms. I trace the source. Invest in your brain. #pulsatiletinnitus #IIH #brainhealth
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If Christian Dior were alive today, he might design a hat not for fashion’s sake, but for the women guarding the mind’s delicate spark. A tribute to those who heal with precision, strength, and grace. #brainflow #brainhealth #brainpressure
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Today we hear from @DavidAltschulMD, who says diversity brings new ideas and creative innovations to the field. As a member of the Women in Neurointervention Committee, he’s a strong ally to female neurointerventionalists—especially his wife, @DrAltschul. #WeAreNeurointervention
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Threading a 0.014” wire into a 3mm brain vessel. No distractions. No second chances. This is brain intervention. This is couture. #FocusIsTheNewCouture #Neurointervention #WomenInMedicine #CocoDiorMD
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Let me show you what I see inside the brain every day. Spoiler: Everything is smaller than you think. Average brain artery 2.5-3.5 mm. One peppercorn = 3 mm. Now imagine navigating to that… Inside the brain. Without open surgery. As a neurointerventionalist, I..
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Cerebral venography and venous manometry remain vital tools in neurovascular care, complementing non-invasive imaging like CT and MR venography. This review explores their evolving roles, key indications, and technical tips to optimize outcomes in cerebrovenous disease evaluation
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