Advice on objective testing to confirm/exclude Vascular Eagles

General
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Hi everyone. I would really appreciate some advice on any objective testing you may have had done in relation to vascular Eagles.

I’m based in New Zealand and Eagles Syndrome is very poorly understood here, some specialists discount that it is a ‘thing’. I have had ongoing right sided tinnitus, ear and head fullness, dizziness and severe brain fog following a bad cold in September 2025. My CT angiogram report describes compression of both internal jugular veins between the styloid processes and C1. It estimates about 80% narrowing on the right and 40–50% on the left.

I saw a neurosurgeon today. He asked me to turn my head to each side and hold it there while he checked my pulse rate. My pulse stayed stable and my tinnitus did not increase. Based on this, he told me he had ruled out vascular Eagle syndrome, that he didn’t believe that my symptoms were a result from the compression because of this test.

Has anyone else had this head turning and pulse check as part of their Eagles assessment? What did your specialist say it could show? I’m trying to understand whether a normal result can exclude jugular vein compression as the cause of symptoms, and whether others had further testing to assess that. I managed to convince him to refer me for Dr Rao’s CCI protocol (neurosurgeon based in Australia) for MRI and CT testing with extension, flexion etc but he refused to refer me for a MR and CT venogram to check outflow. Would appreciate your thoughts.

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That doesn’t sound like a conclusive testing method. Ultrasound flow measurements would be better, and jugular venous manometry best. Probably should consult an eagle’s surgeon from the forum list and review your CT angio.

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@StanleysMum I haven’t yet heard of taking a carotid pulse as a testing method for VES. Many members start out with a CT venogram. Mine was just in one position, neutral, but other members have done it dynamically with flexion and head rotations. If that imaging indicated compression on your IJVs a more invasive, IR venogram with manometry can measure the pressure changes due to the stenosis. Some surgeons require that test others don’t. Dr. Hepworth has an ultrasound protocol that he uses. If you were to get an ultrasound you would want to make sure that the person knew how to perform the protocol.

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It’s beyond frustrating, I’ve never heard of a doctor doing that before… it’s venous compression which needs investigating, not your pulse rate, & you already have that confirmed from your CT ! Whether your veins get compressed in with head turning is dependent on the angle the styloids grow anyway; it’s more common for the compression to be worse when looking down with IJV compression anyway.

Ultrasounds of the veins can be done, as the others have said, with your head in different positions, but it’s not always that accurate…Here’s a link to Dr Hepworth’s protocol if you do want to get this done:

Dr. Hepworth’s protocol for CTV - General - Living with Eagle

Some doctors request a CT venogram with pressure testing manometry, this is a more invasive procedure and does have some risks , it is a more accurate test so you could look into that. Some doctors also do a lumbar puncture to see if the intracranial pressure is raised as it does with IJV compression, & use this as another diagnostic tool, that again does carry a risk so I refused this when I was getting assessed for IJV compression- I saw one of the most experienced doctors in the UK for this, & he was happy to offer surgery just looking at the CT with contrast, and okay without doing any more testing.

The testing that your Neuro has suggested could potentially help- if you do have high intracranial pressure this can show up on an MRI, the CT could possibly show how big the gap is between the styloids and the C1 with extension and flexion, which would indicate how much compression there could be- so they wouldn’t be a total waste of time if you want to do these?

You could possibly print out a research paper or two about IJV compression , symptoms & how this is diagnosed if you’re going to see him again, or send your imaging and report that you have already confirming IJV compression to Dr Rao. I guess you probably wouldn’t want this doctor doing surgery anyway, so if you think you’d have to go to Oz for the surgery maybe just send your scans over?

We have these doctors on the list in NZ, I don’t know how knowledgeable they are about VES though, but whether they would be any help?

Mr. Kevin Smith, Otolaryngology Head & Neck Surgery Specialist, Auckland - https://headandneckservice.co.nz
•Dr. Charles Davis, Plastic & Craniofacial Surgery - https://charlesdavis.co.nz
•Mr. Muammar Abu-Serriah (in the same office as Mr. Kevin Smith)

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