Name

Graham Scanlon

Age

26

Discord Username

ascallion

Blood Pressure

2025-08-27

130/72

2025-08-20 Injured

145/79

2025-03-10

122/74

2024-12-20

130/82

Summary

Tentative Diagnosis

Thoracic Outlet Syndrome - Cerebrovascular Hyperperfusion

Protocol

• Beta blockers to lower blood pressure
• Start provocative strengthening of the scalenes.
  • Scalene medius strengthening exercise. Be very careful with this exercise.
  • Do so very gently twice weekly, no more than 5 reps per muscle. You SHOULD be worse the next day.

  • I feel worse between 2 and 36 hours after performing this movement, peak around 4-6 hours.

  • This causes me to feel upper back pain (around the middle trapezius / upper rhomboids).

  • Transitioned into more subtle eye pain / strain / discomfort the following day.

2026-02-17

@ 12:40

& FUNDUS

& CAROTID

Your current chief complaints and any relevant history

TODO

Do you have any other serious illnesses that I need to know about?

• Arms feel like they are wanting to go numb when falling asleep. No pain or tingling.
• I do NOT have trigeminal neuralgia.

Questions

• Ask about flickering vision.
• Ask about hand coldness / stiffness.
• Why does tos get worse when lying down?
• TOS and holding your breath?
• TOS and fatigue?

2025-12-15

@ 12:00

& MRI

Your current chief complaints and any relevant history

Head throbs (unable to stabilize my heartbeat). Suspected suboccipital injury. Developed slight binocular vision dysfunction.

I snapped something in the back of my head (head in flexion and under strain) and had a spinning headache that became more subtle over time, but never fully healed. Symptomatology gets worse over the course of the day, with upper body workouts (or anything requiring cervical stability) making it worse as well. Laying the back of my head on a pillow makes the throbbing more noticeable.

Sometimes when my head pulls (think eating something and bring the head to meet the food), something clicks in the back of the neck.

What helps the most is doing vision therapy exercises to strengthen the eye (and I think suboccipital) muscles, strengthening the levator scapulae, and rest.

My cervical posture is also not great.

Do you have any other serious illnesses that I need to know about?

• Binocular vision dysfunction.
• Trigeminal nerve dysphoria.
• Suspected chronic clenching.
• Possible referred pain in my teeth and eyes.
  • Jaw issues? My teeth click with my heartbeat when held close together at night.

Questions

• What's likely injured? Left or right side?
• Exercises to strengthen the suboccipital muscles?
• Is it possible to get better imaging when my head throbs?
• Exploratory surgery? What type of surgeon?
• Ask about cervical posture.

Notes

• He says that he fell off a ladder and onto his head approx a year before onset of symptoms. approx 6 feet of altitude.
• He says he has no neck, upper back chest or arm pain
• He says that pushups, pushing overhead, carrying a backpack, makes it all worse
• TOS CVH main suspicion
• We don't have a brain MRI
• Most of his actual pain is behind the eyes
• No jaw sx nor hx
• He says that some of his sx fit with the trigeminal nerve zones
• I suggest a brain MRI to exclude intracranial causes of trigeminal neuralgia

Upper Cervical MRI

MRI has a lot of movement artifacts. Pt states that he feels such an occipital pulsation that it makes the head move!

• Grade 0 anterolisthesis C2-3, grade 0 retrolisthesis C4-5
• C2-3 mild to moderate stenosis left foramen
• C3-4 mild left
• C4-5 bilateral mild but no obvious root stenosis
• C5-6 mild right
• C6-7 mild left

Self-Tests

He says that the response from shoulder loading is always delayed, so I cancelled the Eden's test for now seeing as the history is more conclusive.

• CRT reproduces his symptoms.
• Valsalva also reproduces the symptoms.

Tentative Diagnosis

Thoracic Outlet Syndrome - Cerebrovascular Hyperperfusion

Protocol

• Beta blockers to lower blood pressure
• Start provocative strengthening of the scalenes. (scalene medius)
  • Do so very gently twice weekly, no more than 5 reps per muscle. You SHOULD be worse the next day.
  • Be very careful with this exercise.

Imaging

For Exclusion

• Brain MRI standard sequences (no contrast).
  • Intracranial trigeminal nerve compression
  • Cerebro venous sinus thrombosis of stenosis

For Acquisition

• Doppler ultrasound of the carotid and vertebral arteries.
• Get fundus pictures from an optometrist (NOT EYE DOCTOR).