Ctv brain / cta-ctv neck results HELP

Hi everyone . I had a really hard time getting scans done due to incompetence, but I finally got them though not exactly as requested ( dynamic) and was wondering if a kind soul would give me their informal feedback since i dont know ill be able to see the dr who ordered them ,everything is chaotic right now and its very hard to fight against a system when ill. appreciate your help.

so… this is all i have

BRAIN CTV
Contrast: 80 mL of Isovue-370
Findings: The ventricles are normal in size and contour. Allowing for the presence of contrast there is no acute intracranial hemorrhage. No extended signs of an acute territorial infarction are noted. There is no mass effect or midline shift. Trace
mucosal thickening is noted in the ethmoid sinuses. The calvarium reveals no acute osseous abnormality.The dural venous sinuses and major cortical veins reveal no significant flow-limiting stenosis or occlusion. The right transverse and sigmoid sinuses are dominant. The left transverse and sigmoid sinuses are slightly hypoplastic. No focal filling defect s seen to suggest an acute dural venous sinus thrombosis.
Impression: No evidence of an acute dural venous sinus thrombosis or occlusion

.

NECK CTA/CTV
The CTA of the neck is moderately degraded by motion at the level of the carotid bifurcations. This region is however adequately visualized on the delayed CT acquisition.The left vertebral artery originates directly from the aortic arch, which is a normal variant. The brachiocephalic, bilateral subclavian, and bilateral vertebral arteries reveal no significant flow-limiting stenosis. The right vertebral artery is dominant and the left vertebral artery is hypoplastic. The bilateral common carotid and cervical internal carotid arteries reveal no significant flow-limiting stenosis. There is tortuosity of the bilateral distal cervical internal carotid arteries. No discrete intimal flap or luminal irregularity is seen to suggest an acute dissection.

On the delayed CT
the bilateral internal jugular veins are patent. The right internal jugular vein is dominant. No focal filling defect is seen to suggest a venous thrombus. The ventral aspect of the right internal jugular vein is slightly flattened at
C1 secondary to the adjacent styloid process; although, no significant stenosis is appreciated.There is straightening of the cervical lordosis. The thyroid gland has a slightly heterogeneous appearance with nonspecific low-density nodules. The largest in the right lobe measures 1 cm in transverse diameter (series 4 image 71) and the largest in the left lobe measures 0.6 cm in transverse diameter (series 4 image 72).

IMPRESSION:

  1. No significant flow-limiting stenosis in the neck.
  2. Slightly heterogeneous appearance of the thyroid gland with nonspecific low-density nodules.

So my (non-medical opinion) is that you have a mild compression of the Internal Jugular Vein on the right side, it’s being compressed between the styloid on the side and the C1 process I think by the sound of it. It says it’s not a significant compression, but as your scan wasn’t done dynamically, it could be that with certain head movements (like looking down for example) that the compression could get worse, we don’t know that for sure though. Also significant is that your right side IJV is your dominant one, so any compression on this side will have more of an impact than compression on the other hypoplastic/ smaller side, as it carries more blood. There’s no mention of collateral veins though- if there’s compression sometimes other veins can enlarge to compensate, which helps with head pressure.
The report also mentions straightening of the neck lordosis-that’s the natural curve your neck should have, so your neck is too straight, also known as military neck. There have been lots of discussions about this on the forum, as it does seem to make ES symptoms worse, but there are exercises you can do to improve this, here’s a link to @vdm 's posts:
Question for those with military/straight neck (loss of cervical lordosis) - General - Living with Eagle
It doesn’t mention the length of the styloids though- I’m sorry, I can’t remember if you’ve already had a scan showing elongated styloids or report which states their length?
I don’t know too much about thyroid nodules & what symptoms they could cause, but it does seem to be something quite a few members have had. Others hopefully can give you info about that…

As I agree w/ everything @Jules told you, I will discuss the thyroid nodules as I have those. They are usually benign & tend to come & go. In my case, I have a couple that are larger & have calcified. When they calcify, there is a greater risk of them becoming cancerous so I go in for an ultrasound every 6 months to get them checked for changes. So far, so good. Once you get your IJV compression/ES dealt with, you may want to see an endocrinologist about the thyroid nodules just to make sure they are benign.

I’m sorry you’re having trouble finding a doctor who will commit to help you. I hope now that you have the information you sent us, you’ll be able to be taken seriously & will be offered surgery so you can put this all behind you.

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Thanks Jules . Even if it says “slightly flattned or no significant stenosis is appreciated” yu would still consider as relevant info? Also would the dimensions of styloid be able to be noted in that type of exam if i ask for that info. When considering dimensions do radiologists measures seaparatley the styloid and the ligaments or is it acombined measurement? all my prev exams noted way different measurements thats why i wamt to do a recent reglar ct w contrast( or wtha dn without unsure whats the correct protocol) i will write to w as well. thank you

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Hi @Eli, haven’t read through your prior posts, but I just wanted to mention that despite the non-dynamic CTV showing good patency of the IJV, I don’t know that anyone’s checked any of your imaging for signs of intracranial hypertension.

Namely, I’d look for any kind of concavity of the superior aspect of the hypophysis (aka pituitary gland), also known as an emptying sella turcica, which is the easiest thing to do. Then I’d check if you’ve had any fluid-attenuated MRIs done (I’m poorly read on which protocols apply, but eg. T1-FLAIR or T2-TSE DARK FLUID) to look for any peri-ventricular non-focal/diffuse/cloudy white-matter hyperintensities. There are a few more that I’m blanking on right now, but generally, I don’t trust whoever wrote those reports to have checked for intracranial hypertension. And, as @Jules mentioned, not knowing what your head and neck positioning was during the imaging, I wouldn’t be able to rule out whether the observed IJV stenosis becomes significant during your day-to-day activities, or while sleeping. Any signs of intracranial hypertension would suggest that the IJV stenosis could be a problem. I’d wonder whether your chin was extending upwards or downwards or neutral during the imaging. If it was extending upwards, then in all likelihood the imaging was captured while the stenosis is least severe.

If you can get comfortable with opening up the DICOM files for your imaging studies, it’s not all that technical to get a working measurement yourself. Like, there are more and more rigorous ways to measure it, eg taking curvature into account, but really, you can apply your own critieria for measurement and compare it with what the radiologists are telling you (I doubt that any radiologists do a slide-by-slide measurement that takes curvature into account unless they do research in ES). Basically, the formula for straight-line distance in 3-d space is Length-squared = Delta-x-squared + Delta-y-squared + Delta-z-squared. You can pick which slides the styloid starts and ends at in all three dimensions and note the location in mm that the software tells you those slides are at.

I’d recommend getting someone beside you to do the clicking and such for you lest you exacerbate your condition.

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If the styloid & stylohyoid ligament have fused to produce the elongated styloid then the measurement will be of the whole thing. If there is styloid elongation then a gap then some calcified s-h ligament, there should be two measurements, one for the styloid & one for the separate section of calcified s-h ligament.

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It’s just my personal opinion, but there does seem to be quite a variation with radiologists etc with what would be considered significant compression; some believe that as you have 2 IJVs that you can still manage with only one so don’t consider compression that important! My point is that because it’s your dominant side which is compressed, this means that a even a smaller compression will have more of an effect than if it was your non-dominant side. But whether a doctor will consider that I don’t know, it would depend on whether you’re able to see someone with knowledge of vascular ES…
I agree with @Isaiah_40_31 about the measurements, but some radiologists again measure the ligaments and the styloids together, sometimes there’s a sort of joint at the end so you can see where the styloid finished and the ligaments start…

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