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However, imaging findings, particularly in the case of partial obstructions, may be subtle enough that obstruction of no identifiable cause is recognized or no overt signs are apparent

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Functional signs that may suggest undermethylation or impaired methylation efficiency include: High internal tension Perfectionism, rumination, or OCD traits Chronic anxiety Low serotonin or low motivation Poor response to SSRIs Sensitivity to folate or methyl donors Increased inflammation Elevated homocysteine with normal or low B-vitamin status A methylation test that measures SAM, SAH, and homocysteine helps clarify the exact biochemical pattern