Hi Buzz, I was able to quickly look at your 2020 MRI and 2014 CT. Since we already know that you have IJVS caused by C1 & Styloid compression, I tried to look beyond those and found a few things that need to be confirmed with additional investigation. Both the significance of them and the clinical relevance need to be established with additional specialized imaging.
Left Internal Carotid Artery (ICA) and Styloid Contact : I have found that your elongated Styloid is rubbing against your ICA and could potentially be compressing/irritating it when you look down. Typically, Carotid compression/irritation mainly manifests as (Syncope, presyncope, vision changes, dimmed vision, slurred speech, difficulty speaking, lower cranial nerve dysfunction. Horner’s syndrome, ptosis (drooping eyelid), constriction of the pupil, loss of sweating over the ipsilateral face, upper/lower extremity paresthesia. Weakness or paralysis of face, arm or leg, dizziness, unsteadiness, or falls.). So this needs to be investigated with dynamic angiogram specially in flexion position (bending the neck down) to see if it is compressing it. I am not a doctor, but based on literature, it could potentially cause stroke as well so this needs an urgent addressing.
Here are Axial and Coronal images of Styloid (Cyan arrow) and ICA (Red Arrow). Axial image shows the contact well.
Here are the 3D images of the elongated left Styloid (Cyan arrow) and left ICA (Red arrow). You can see the Styloid resting against ICA. Imagine what it could do if you flex your neck.
So the left Styloid is not only messing with the left IJV & ICA but I suspect it is also messing with Glossopharyngeal Nerve, Vagus Nerve and since it is rubbing the Carotid, it is irritating the nerve fibers on the Carotid body such as baroreceptor as I think some of your symptoms match them. I listed the symptoms from them below and the source Study link is provided as well. It is good study to read if you have not read it before.
Here is an internet image that shows the close proximity of GPN, Vagus, Carotid and IJV. Think about the terrain that the elongated Styloid is travelling
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Carotid Sinus Body irritation symptoms. I highlighted the ones I thought you might be interested.
Glossopharyngeal Nerve, Vagus nerve and ICA irritation symptoms. I highlighted the ones I thought you might be interested.
Source Study Link : https://emergeortho.com/wp-content/uploads/2018/04/1-s2.0-S2468781220301399-main-2.pdf
Suspicious CSF leaks along the Cervical and Thoracic Spine : I also find what suspiciously appears as CSF leaks on your cervical spine C1-C2 area and various areas of thoracic spine (from T5-T11). I am not sure the significance of this because a lot of us, IIH suffers, leak CSF in various places along the Dura (both in the brain and spine). This is due to the raised intercranial pressure so any weak area of the dura gives in and leaks CSF spontaneously. The good thing is the majority of IIH leakers do not suffer from the debilitating symptoms of CSF leaks since our CSF is already high and sometimes it works to our advantage since it lowers the pressure a bit. Anyways, regular MRI is not sensitive enough to detect them so this finding needs to be confirmed with special MRI Myelogram if you deem significant enough to investigate it further otherwise be aware of them. CSF leaks typically resolve after taking care of IJV compression and lowering the IIH.
MRI T2 2020 shows suspicious CSF Leak on the nerve exits called bilateral neural foramina (Cyan arrows) C1-C2 area. This needs to be confirmed with specialized MRI such as MRI Myelogram.
For a reference of what normal look like. No suspicious CSF leak on C3 - C4 is seen here. CSF appears to be contained where it should be
MRI T2 2020 shows suspicious CSF Leak on the nerve exits called bilateral neural foramina (Cyan arrows) on T4 - T5 area. There also suspicious multiple CSF leaks on nerve exits (Yellow Arrows). This needs to be confirmed with specialized MRI such as MRI Myelogram.
Even if CSF leaks are confirmed in your case, I would not worry about them if they are not causing any severe symptoms. I, myself, leak them on my nose, ears at times. So proceed with opening up the IJV and removing the Styloid. That usually resolves them. Here is a good study from Dr. Higgins in UK. that talks about it.
Source : https://www.tandfonline.com/doi/pdf/10.1080/21641846.2021.1956223
IIH Markers are seen on the MRI: I have also noticed the other tell tale signs of IIH. Optic Nerve Sheath dilation (ONS) and milder partial empty sella which both are considered a good marker for IIH.
MRI 2020 T2 Axial & Coronal show CSF filled Optic nerve sheath (Red arrows). CSF is white on MRI T2
MRI 2020 Sagittal shows partial empty sella another marker for IIH (Cyan arow). Note CSF is dark/black on T1 MRI.
