Most of these are found by accident. Or mistaken for something else.

• A whooshing or pulsing sound in one ear, in time with the heartbeatOften managed as an ear problem for years. It can come from a dural fistula, a narrowed venous sinus, or carotid disease. More on pulsatile tinnitus.
• Confusion, unsteadiness or slow decline in an older adultSometimes weeks after a knock to the head no one thought important. Chronic subdural haematoma is regularly mistaken for dementia, and is highly treatable.
• An aneurysm reported on a scan done for something elseIncreasingly common as MRI use grows. Most are watched rather than treated. More on aneurysms.
• A red, bulging or pulsating eye with double visionOften treated as infection or thyroid eye disease. A carotid-cavernous fistula behaves this way and is closed through a catheter.

• A first seizure in adult lifeWorth imaging properly. An arteriovenous malformation or a cavernoma may be the reason.
• Headache with blurring of vision, worse lying flatRaised pressure inside the head. In selected patients this comes from narrowing of a venous sinus and can be relieved by stenting.
• Slowly progressive leg weakness with bladder difficultyUsually attributed to spinal degeneration. A spinal dural fistula can cause it, and the weakness becomes permanent if missed.
• The worst headache of your life, beginning in seconds EmergencyA ruptured aneurysm until proved otherwise. So is sudden face droop, arm weakness or slurred speech. Call +91 76780 63385 and dial 108.

Background

Trained in both routes to the same vessel.

Most surgeons who treat cerebrovascular disease are trained either to operate on the brain or to work inside its arteries through a catheter. Dr. Ambekar completed fellowships in both — skull base and open microsurgery in Shreveport, endovascular neurosurgery in Miami — and returned to Mumbai in 2015 to practise them together.

That matters for one reason: the recommendation you receive is not shaped by the only technique available.

More about Dr. Ambekar →