Hi, I have internal jugular compression on my right due to elongated styloid process. My CTA diagnosis is Eagle Eyndrome with mild jugular vein compression from the pointed end of the styloid on the Right. Both are elongated though. The doctor asked for the CTA to be with turned head as well but the hospital said it would be too much radiation. So, due to symptoms, assuming it is worse when turned, looking for info on if anyone sees a reason in this to have the more advanced surgery with the transverse atlas being shaved or if just a styloidectomy may be fine. I have lots more images, just don’t know which one will show all this.
I started severe neck pain and stiffness when I woke up one day 2 years ago with severe dry eyes too. Went to piles of doctors and eye doctors/ PT for 9 months then found out I have Classical Ehlers Danlos but no answers on neck pain at the time except possible instability. There are no stand up MRIs near me. Stopped PT and have been going to upper cervical chiro where they just use a tool to push C1 back in every couple weeks from under my ear. It helps some pain but then last summer, woke up with barely any vision in my right eye. Went to ER.. had MRI and went to retina specialist but nothing was found. My vision returned the next day but floaters started and a month ago got so extreme I was also seeing lightining flashes in my R eye. Went to another retina specialist who found a brand new issue Vitreous Detachment (the gel in eye covering the retina) which I now know can be caused from intercranial pressure.
I can no longer lay flat or I get severe jaw and ear pain. I had to stay in a hotel last week and woke up screaming from face and head pain on my right. I know I will have to get the Styloid on that side removed but to top it off I also have Mast Cel Activation and Lupus so I can barely take any pain meds and my inflamatory response is so big that the surgery is a risk of a major Lupus flare. I’m hoping I don’t need the C1 shave too and that it’s just styloid removal that I might need.
Can anyone tell anything on this?? Any different images I should upload?
Thx for any info!!!
Hi & welcome!
Your styloid is certainly elongated and quite angled, so not surprising that you have symptoms!
I can’t see any obvious compression on the IJV from the styloid in the image you’ve posted, and I can’t see the C1 process so can’t tell whether this is causing your compression. There is a small blood vessel crossing the IJV, sometimes these can cause compression. I don’t know if you have any more imaging you can share?
I understand that you don’t want a C1 shave unless it’s really necessary , and that with your other medical conditions surgery could well be complicated, but given that it sounds like you have intracranial hypertension, you really need to get this right first time. I would suggest that you do try to get a consultation with one of the vascular ES doctors on the list, if not more than one opinion. The best doctors would be Dr Costantino in NY, Dr Cognetti in PA and Dr Lui in NJ…
So, sorry, it’s not possible to give you an answer about the C1 shave from this image…
Thank you so much for your reply!! My records were already sent to Constantino and Lui so I’m glad you mentioned them. I just updated my post with more images but honestly… I can’t tell what I’m looking at. I only know there is compression because of CTA report stated it.
I’m sorry you have so many health challenges you’re dealing with & now have vES added to the mix. I’ve had the vitreous detachment in both eyes w/ one occurring about a month after the other. It was pretty scary not knowing if my retinas might tear but thankfully they didn’t. My vitreous humor didn’t fully detach from either retina so here’s hoping it’s happy where it is & there’s no future movement.
I’m sorry if we haven’t suggested for you to sleep w/ head & shoulder elevation. That’s something that helps a lot w/ vES when the IJV is compressed. You may need to experiment w/ how much elevation is most helpful for you in reducing symptoms. Icing your neck can help - 15 min. several times a day using a thin cloth between icepack & skin to prevent ice burns. If ice makes pain worse, try heat. Gel packs are available that can be frozen or heated for that purpose. OTC lidocaine patches have also been helpful for a number of our members. They are 5% lidocaine but you can get stronger ones via Rx.
Thank you for uploading your imaging. Can you add pictures of your left side? I annotated several of the pictures you posted.
There are several things I see which could be causing your IJV compression: 1) Your right styloid is partially wrapped your IJV. 2) There’s a small vein or artery lying across your IJV. 3) The transverse process (TP) of your C1 is bifurcated on the right i.e. two “heads” on the TP which are both contributing to compression. That may be a form of ponticulus posticus or it may just be a C1 anomaly. You’ll most likely need C1 to be shaved, however the way the styloid is positioned, just having a styloidectomy might be all that’s needed for your IJV to open up. Since I’m not a doctor, I can’t give you a true medical opinion.
Also, though I didn’t mark it, your cervical spine is very straight thus has lost it’s natural lordotic curve. When the cervical spine is straight, the styloids & hyoid bone move closer to nerves & vascular tissues in the neck. Here’s a link to a post that has some good information about how that can be fixed though it requires much patience & time: List of my favourite resources on YouTube to learn anatomy
