Collateral veins, vertebral arteries & asymmetry on MRI

Hi @M_UK ,

Thanks for replying to a recent topic where I asked for advice on my upcoming surgery with Mr Axon. As ours scans, symptoms and now surgery are so similar I wanted to ask a couple questions of you and anyone else on the forum. I understand completely if you find it difficult to reply.

I would rather go into the surgery with a realistic attitude and see it as the next stage in trying to find answers rather than get too optimistic that it will be a cure-all.

I sound very similar to you in many aspects, one major difference being that my sudden acceleration in symptoms started a couple of years ago with a bad attack of vertigo after bending over. Since then I have declined quite rapidly, but I would say the most debilitating element is the dizziness. I don’t really know how to describe it - it’s not really dizziness but almost a combination of dizziness, fatigue, vertigo and brain fog. It seems to strip me of all pleasure as I can’t seem to focus or assimilate anything around me, so a blue sky day or a conversation with my kids no longer gives me any enjoyment. Even trying to focus on someone’s face whilst they are speaking is very difficult & makes me feel worse. The best physical description is probably a slight sucking, fuzzy sensation at the centre of my head. If I could just get rid of this alone there would be aspects of my life I could enjoy again. I wondered if you identified with any element of this.

I also wanted to ask if you had had ballooning or a lumbar puncture before hand and did it give you any slight relief even if transitory?

Also did you ever get a copy of the CT scan done straight after surgery? (you may already know this but there’s an easy way to do this from Addenbrookes & my scans came back within 2 days).

I noted your diagnosis of tonsillar herniation and presume it was relatively mild if not spotted initially on MRI - was it more pronounced on one side by any chance and did you have any asymmetry in your ventricles?

The main thing I wondered about that might be affecting you and I are the collateral veins. I noticed on mine that I seem to have an accumulation around the vertebral artery on the right side and it looks a little that way too from your scan.

This looks like it would be affected by rotation & flexion too which certainly seems to be the case with me. It will be interesting to see if these have disappeared on our respective CT scans post op.

For me I have about 10 minutes in the morning before the dizziness kicks in. In my mind this doesn’t completely fit with the jugular vein compression as I know the JVs collapse in the upright position and then the vertebral venous plexus & other veins take over.
I’ve highlighted on mine here

And yours (hope it’s OK to copy & paste yours - I would love to know how you did the bottom right subtraction image btw)

Just interested in your thoughts on this and whether you are affected by movement & rotation. I wondered if this build up might impact the vertebral arteries too. Just in case you or anyone else has similar MRI I’m posting an image of my next area of investigation if the surgery doesn’t work for me - Vertebral Artery Compression Syndrome, which it’s possible I may have based on my imaging. It’s compression of the medulla/brain stem by a tortuous vertebral artery.

Sorry for all the questions and as I said I completely understand if you don’t feel up to replying or just simply want a break from it all. Hopefully if we have had this for a while it will just take longer for us to improve. Wishing you the very best.

Input from anyone else too much appreciated.

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Yes I definitely relate to your description of the dizziness! I had the balloon angioplasty and lumbar puncture and experienced temporary relief of symptoms from both.

I did a post on my post surgery CTV, comparing it to my pre surgery CTV. If you do a search you should be able to find it. Basically my jugular was actually more narrowed after the surgery than before and the collaterals were unchanged.

Yes my tonsillar herniation would not class as traditional Chiari. It was more pronounced on the right. I’m not sure about the ventricles.

I wish you all the best with your ongoing investigations.


Thanks for replying - I’ll take a look at your CT post. Do hope you get some resolution and at least get to see Dr Higgins soon. The situation with the NHS is a nightmare at the moment I know. Hopefully he can at least help you make a plan, I asked him at one point ‘You won’t give up on me then?’ and he said he never gives up on anyone.


If the balloon angioplasty gave you brief relief, would stenting help then…sorry if you’ve discussed this before, I can’t remember!

Yes stenting may help and indeed this is Mr Axon’s favoured next step if the right jugular is still just as compressed on the next CTV. My concern though is a lot of people have pain with a stent in the jugular and once it’s in it can’t be taken back out. It’s a very tricky decision.

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@M_UK I know many people think I’m nuts talking about military neck, but…
I had another look at your before/after scans and would suspect your IJV might be compressed because the vein itself and the muscles around it have been stretched. The compression looks along the whole length in the

I suspect, like a deflated balloon, if you stretch it longitudinally, the vein flattens out and gives more resistance to any fluids going through (unless the vein has really stretchable walls that I doubt). Add the artery going through the same vascular compartment

, tight scalene and SCM muscles, and the pressure on the weakest part (the vein) is unavoidable.

And the military neck/stiff neck itself may be not the primary cause, but the result of stiff and straightened thoracic spine, which can be caused by many things from stiff ligaments or spasmed muscles (even the ones someone recently showed on Kenhub - semispinalis capitis

) to locked rib joints.

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Yes, it’ll need thinking about…hope that you don’t have to wait too long for the CTV & follow-up.

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