Thanks Jules for your encouragement. Am still searching for a surgeon with no results. My ENT seems to have given up since he says there is no ENT to do external surgery in SLC. Sort of at wits end here with al the pain. I do believe it’s more than just classic ES…see article I am attaching where I’ve highlighted my symptoms… However if local doc doesn’t have info to confirm Vascular ES, I have nothing to send to docs in other places. Geez!! I’ve tried lighting afire under him with virtually no results and am so frustrated. If others have these same symptoms I have highlighted and have had a diagnosis or surgery for Vascular I would love to know. We have actually faxed my records & ct down to Dr Eusterman in Denver as he is contributing author…however there has been no reply when we’ve followed up. So basically ruling him out! Thanks to anyone out there who can offer help and advice.
Vascular ES
Symptoms common with Vascular ES are
***dizziness,**
*weakness, or
*fainting (syncope).
The styloid process is located between the External and Internal Carotid arteries, so if it is angulated, it can compress either of these. The stylohyoid ligament, if compressed, can aIso compress the arteries.
It is possible that compression of the External or Internal Carotid arteries could temporarily cut off part of the blood supply to the brain, leading to a temporary loss of consciousness. Many people have found turning or moving their head into a certain position causes this, as this can move the styloid process or calcified ligament and so compresses the artery.
In addition, pressure on these arteries can irritate the sympathetic nerve fibres in the artery walls, and this can send pain signals all along the artery. The ICA branches to the Ophthalmic artery, so if blood flow is reduced to this, there will be eye pain, and vision problems. Research states that if the ECA is compressed, pain is in the infraorbital (below the eye and to the side of the nose), temporal, and mastoid regions (below and behind the ear). If the ICA is compressed, then pain is in the ophthalmic area (E.Beder, Ozgursoy, Karatayli: Current Diagnosis and Transoral Surgical Treatment Of Eagle’s Syndrome).
And also ‘Hence, if the external carotid artery is affected, the patient may complain of pain in the neck on turning the head, or pain radiation to the eye, ear, angle of the mandible, soft palate and nose.
When the internal carotid artery is involved, pain over the entire head and larynxmay be involved.’ (Correll RW, Jensen JL, et al. Mineralization of the stylohyoid-stylomandibular ligament complex. Oral surg Oral med Oral path 1979.)
Pressure on the ECA can also contribute to jaw pain. Dizziness could be caused by compression of the Hering Nerve, which is a branch of the Glossopharyngeal Nerve, and connects to the carotid sinus to help regulate blood pressure. Also if there is compression or irritation of the carotid sinus- the area just before the carotid artery splits into the ECA and the ECA- this can affect the vagus nerve, and through the parasympathetic nervous system can affect blood pressure and heart rate.
The symptoms if the Jugular veins are compressed are slightly different. Because the veins take the blood flow from the brain, any compression of these interrupts the blood flow coming from the brain, and so therefore can increase the pressure in the brain (Intracranial Pressure- ICP). ). Over a long period sometimes other veins can compensate and take the blood flow away (‘venous collateral drainage’- Callahan et al). If the pressure in the brain increases, this is known as Intracranial Hypertension. Symptoms of this are also dizziness, plus headaches, tiredness, slow or confused thinking (brain fog), feeling of pressure or pulsing in the head and neck, feeling of pressure in the ears, pulsatile tinnitus (hearing heartbeat, often a whooshing sound), feeling generally ‘out of it’ or off-balance. It can also cause other neurological symptoms such as feelings of falling, or feelings of pressure on the head ‘like you’re wearing a hat’.
The impact of elongated Styloid processes compressing the jugular veins is the subject of a research paper- ‘New Eagle’s Syndrome Variant Complicating Management Of Intracranial Hypertension After Traumatic brain Injury’, by Callahan, Kang, Dudekula, Eusterman and Rabb- where there authors conclude ‘We believe that this demonstration of venous compression constitutes a new variant of Eagles Syndrome… This variant of Eagle’s Syndrome may represent a rare cause of such venous insufficiency that should be in the differential diagnosis of unexplained or disproportionately elevated ICP.’ The authors stated that the patient’s styloid processes were ‘elongated and posteriorly positioned’.