ES /VES diagnosing tests help

What’s the best exam to diagnose ES/VES?

Hi community. I had a ct cervical spine w 3D and a ct neck soft tissue ( both w contrast ) from a year ago that shows calcified ligaments butw discrepancies in styloid lengths , but would like to have exam up to date since my symptoms are 10x worse .From my understanding, a CTA/CTV of head and neck would be it and would show vascular compression?, and perhaps a FIESTA /CISS MRI sequence would show nerve compression?Unsure if a regular orbit/face and neck MRI would show same info as the fiesta sequence?. Any info is much appreciated.
Thank you very much your help

Hi Eli -

A dynamic CTA/CTV will show vascular compression & should also show your styloids.
An MRA/MRV is also good but will use gadolinium contrast & cannot be done dynamically.

FIESTA MRI or neurogram (Magnetic resonance neurography - Wikipedia) is what’s been mentioned on our forum as being the way to look for nerve compression. I’m not familiar w/ a CISS MRI. A neck MRI wouldn’t show the nerves, even with contrast, but it’s the neck to skull base that you’d want to view for nerve compression by the styloids/stylohyoid ligaments. Most people don’t get those because they’re extremely expensive & the machines aren’t as readily available.

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Hi isaiah
thank you . i have done an upright mri but havent done a dynamic cta
or any cta ctv probablymight be a good idea just to see how things have changed the burning in my mouth is crzay and numbness in teeth plus grinding on throat ;/

. the ciss is the equivalent of the fiesta sequence the name varies by brands of equipments used

i have several tests that drs didnt looked at since done outside teh states even though i have the imagig and translated reports so im pretty frustrated maybe osmeone might be able to help me look
thanks again

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@Eli - If you want to try uploading your images here, we can give you a non-medical opinion, but they will need to be in 3D as most of us don’t have experience with reading the image slices. You can drag & drop them into the text box or use the underlined up arrow in the menu at the top of the text box when you reply. You can send your translated reports to me via PM & I can look them over & comment. Just click on my screen name as it appears above this post & that’ll get you started w/ a PM.

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hi isaiah
can you show me how the order should look like
cta/ctv of neck or neck and bain ?
thank you

I’m sorry, I never saw the orders for my scans as they are emailed directly to the radiation facility.

I saw an interventional radiologist & requested a dynamic head & neck CTA/CTV to look at my styloids & to look for compression of my IJVs (internal jugular veins) & ICAs (internal carotid arteries). He ordered an MRV & a CTA plus a jugular ultrasound.

Did Dr. Hepworth recommend any further testing you should get when you saw him? It seems with all your crazy symptoms, he would be the best doctor to follow your case because he thinks outside of the box & has professional relationships with doctors in many other specialties so has good resources for referring his patients who have problems outside of what he takes care of. I know it’s a nuisance working with his office staff, but he’s working to improve that situation.

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thanks isaiah for the info , its just very frustrating w that office
unsure .i already have a lot of stress going on to add more. also have you heard of any case where he has said that a patient has no compression ? that velocity chart and the report discrepancies to the exam places that he sends his patients seem unusual . i know people say he sees issues than no else sees but why would he send them to a place that he knows isnt accurate? i really want him to treat me, but im a bit let down at the moment ;(

he only ordered an upright mri and jugula us

hi isaiah
Thank you for your note, several questions here sorry. yes i might still try to ask him as you recommended.

how long is a dynamic head & neck CTA/CTV ? havimg trouble lying down .
does it have contrast?would it need nec it to be dynamic if already have an upright mri?

could i just get a ct w 3d of neck but up to date since my symptoms are way worse now.would it differ from a ct w 3d of cervical spine?

i have the 3d ct w contrast and can give you a link that lasts for few days, but you will be able to see already in 3d and perhaps give me a non–professional opinion ? i dont know how to grab which portions of the 3d images
The crunchiness in what it seems end of throat and perhaps radiating to roof of mouth is unbearable ;/ my right side is worse , i dont know how to read i images what is right or left im ignorant

or i could ask for an order of a cta/ctv that i have never done. i have done an brain mri angiorresonance
thank you very much

I’m so sorry, I don’t know what to do w/ the images to see different aspects. I did use the scroll bar that shows up for the image on the lower right & could look at it from other angles which was helpful. The other 3 images are slices & I can’t help with those.

I’m removing your link because it contains the medical report that has your full name & personal contact information on it. My recommendation is for you to send your link in a private message to @LimeZest, @TheDude, or there are others on our forum who might know how to manipulate the images better than I do & can help you more.

You have a lot of calcification in your neck between the styloids & calcified ligaments which are very likely contributing to your symptoms if not the total cause. Calcified ligaments for some reason seem to be the cause of the crunchiness in the throat feeling even though they are lower down in the neck. Your styloids are more likely what’s causing the pain in the roof of your mouth.

Dr. Hepworth predominantly sees patients with vascular compression. They often go to him already diagnosed because it’s seen in scans they’ve had.

Dr. Hepworth wouldn’t use a lab that gives him inaccurate results so I’m curious what velocity chart & report discrepancies you saw in your case? Dr. Hepworth uses the blood flow velocities in the IJV ultrasound to help determine if a person might have vascular compression. If there isn’t already imaging that shows compression when the US indicates it’s a problem, then Dr. Hep sends the patient for more diagnostic testing such as an angio/venogram. The fact that he ordered an upright MRI for you indicates he’s concerned you may have CCI which is often a cause of IJV compression.

The dynamic CTA/CTV uses iodine contrast & takes about 30 min. Since an upright MRI is done w/o contrast, & is for the purpose of looking for CCI, I don’t know if it shows what’s happening to the vascular tissues when the cervical vertebrae are moving. Maybe another of our forum members knows the answer.

A CT of the neck is the same as a CT of the cervical spine. What you want is a head & neck CT with contrast if you’re looking for vascular compression. Have you gotten an updated one since you’ve been back in the U.S.? I know the U.S. doctors don’t want to see the scans you got in Peru. Just a CT with contrast would probably be fine to show what needs to be seen.

Fabi, since your symptoms are so bad, I think it would be a good idea for you to choose a doctor & have ES surgery to see which symptoms recover. After you’re healed, you can decide whether to pursue treatment for your remaining symptoms if there are any.

You’ve gotten opinions from a number of doctors but haven’t settled on one to see for surgery. Dr. Hackman would take out both styloids & stylohyoid ligaments at once which might be really helpful for you. If you haven’t had a consult with him, it would be worthwhile.

The two bones sticking straight out from your neck (below your calcified ligaments) could be the greater horns of your hyoid. I don’t see the rest of your hyoid bone at all which is odd.

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The styloids & calcification do look pretty long & significant @Eli

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