After years of unexplained dizziness, lightheadedness, head, neck, and throat pain, tinnitus, dysphagia, brain fog, fatigue, insomnia, etc., I was recently diagnosed with ES by two ENTs based on CT scans showing elongated SP.
Yesterday I had a CTA to look for possible vascular compression. The imaging was done in neutral position and also in the posture that seems to cause my worst symptoms.
I just received the report, and will meet with a third ENT (Aaron Prussin) tomorrow. The report is copied below. I feel like my lightheadedness may be from some degree of vascular compression. But does this report rule that out? Does this conclusively say that I should focus on non-vascular ES? What questions should I ask Dr. Prussin tomorrow?
Vasculature: There is a normal anatomic configuration of the aortic arch. Normal caliber and contour of the bilateral common carotid, internal carotid, and external carotid arteries. There is no appreciable atherosclerotic plaque at the bilateral carotid bifurcations with 0% stenosis by NASCET criteria. There is no plaque ulceration or intraluminal thrombus. The bilateral vertebral arteries appear patent without significant stenosis. Mild irregularity in the distal V2 segment of the bilateral vertebral arteries. Left vertebral artery is dominant.
No vascular compression with leftward head rotation….
Aerodigestive tract: Effacement of the right piriform recess….
Normal appearance of the bilateral cervical carotid and vertebral arteries without stenosis. No vascular compression with leftward head rotation.
This report says nothing about your internal jugular veins. The symptoms you have are more in line with compression of the IJV(s) possibly between the transverse process(es) of C-1 & your styloid process(es). You need to ask for them to re-evaluate this scan for IJV compression between the styloid processes & transverse processes of C-1 up near the skull base. In rare cases, the IJV is compressed by the styloid & C-2.
For many years, ICA compression was the only type of vascular compression known to be caused by ES. Many doctors & radiologists are not up to date w/ the fact that IJV compression is much more common than ICA compression in Eagles Syndrome patients so the ICA is what is evaluated. I’m sorry they didn’t look at both the veins & arteries in your scan.
You should definitely mention this to Dr. Prussin when you see him tomorrow. We have many links to research papers (under the General category on the home page) regarding IJV compression related to ES. If you can, make copies of one or two to take w/ you tomorrow.
I was thinking the exact same as Isaiah. We commonly need to get the disc with our imaging and look at it (and share with super knowledgeable groups like this one!) in order to better see what is going on. Findings such as vascular eagles (compressed between C1 and styloid typically) are often not even noticed, and if there are they are ignored by radiologists.
Do you know if the CT was only your brain or was the cervical also included? If you are able to share with us prior to your appointment we could no doubt help you look at what’s going on. There are a few free programs that you can use that will build a 3D rendering of the CTV (I use Radiant a as a non mac user) and then you can share pictures from all relevant angles with us, and there is also a free online sharing program (dicomlibrary.com) where you can anonymize the entire set, load it up and share a link.
I agree with @Isaiah_40_31 & @akc that it could be IJV compression; I had bilateral IJV compression & had constant light-headedness, as well as full blown dizzy spells. I had head & ear pressure too, do you have that?
I hope that Dr Prussin listens!