I’m in the process of scheduling a remote consultation with Dr. Constantino. I ran my CTa from a few weeks ago through Radi Ant, but I don’t think it has the data it needs to make a really good picture. Using the Angio filter, I can hardly see my styloids at all. The right side is the most painful, and it’s largely obscured by veins and arteries. The Bones and Skin 3 filter is the only one that gives me a decent view. The photo is of my right side, but I sliced off the left and rotated it to look from the inside. Isn’t it lovely how my writing looks like something from a horror film?
Not clear from this picture, but much of the styloid is actually behind my jaw. It doesn’t seem very long, but the angle doesn’t seem normal. I have hypermobility and definitely get worse symptoms depending on if my neck/skull shifts, but I can’t do all my PT to fix the CCI because chin tucks send my heart rate up, maybe mess with my blood pressure too. I’ve had increasing problems waking at night feeling like I’m going to pass out, getting pins and needles under ears, into jaw, neck, even down arms; often find my head has turned to the right when this happens. I’m getting all sorts of other weird unpleasant symptoms: stabbing in the throat, feeling like there’s something powdery stuck in it, stabbing in the sinuses from the inside, vertigo, difficulty swallowing. Diagnosed with TMD and CCI, but I think I have more than that going on.
EDIT: I forgot to mention that I’ve been dealing with possible gastroparesis since October, and a costochondritis diagnosis too. It all happened at the same time the neck and throat symptoms flared. Neck was starting to feel better until a few weeks ago, PT thought she felt my C1 or C2 slid out to the right and tried to push it back in. Within 20 minutes I developed a sharp pain like I was being stabbed from the inside under my right are, and I haven’t been able to see improvement since. That’s when my difficulty with chin tucks started. The CTa is from after that.
Here is the right side view straight on with the angio filter. You can see here how most of the bone is sandwiched behind vascular structures and my jaw. Idk if this is normal, but that’s what Dr. Constantino is for. I’m glad he does remote consults.
I’m sorry I’m not very techy so can’t give you advice as to how to peel away layers to get to what you want to see, but I think it’s possible. From the little bit of your styloid I can see, it looks very thick & you’re right, it seems to be pointing in toward your spine. The colored image doesn’t look like it’s showing the whole styloid. The good news is that it doesn’t like you have IJV compression in the second image, however, you could have it on the left or have some internal carotid artery compression which can’t be seen at all in the images you posted. ICA compression is more likely to cause dizziness/fainting than IJV compression because a compressed ICA slows blood flow into the brain which reduces the oxygen input to the brain causing light-headedness. Gastroparesis can be caused by an irritated vagus nerve as can the heart & BP symptoms.
I’m really glad you’re working to get an appt. w/ Dr. Costantino. I hope you can get that virtual appt. soon!
Two options are 1) That’s an area where something is squashing your IJV so it’s flatter there or 2) CT scans are done in slices & 3D images aren’t perfect & sometimes leave gaps or artifacts in the images.
Oddly - I can’t see your styloid in this picture at all.
Thank you. I just got diagnosed with my second ICA anuerysm, so I’d love to know for sure whether something is getting compressed. The first was 3mm just outside my skull and went away on its own. The second is 2mm inside my carotid canal. Both are uncommon places to have aneurysms.
Is the affected carotid on the right side? Your ICA aneurysms could certainly be caused by your right styloid if they’re occurring on the right side of your neck.
Yes. That’s also the side I hurt a year ago misfiring a shotgun. Head went to the left, shoulder went to the right. CTa immediately after showed no damage, but I’m suspicious that I developed it after a few months. No more shooting for me.
I had a cycling accident w/ a head injury between my two ES surgeries. When I was initially diagnosed, I believe I didn’t have vES but due to the cycling accident, my C1 vertebra shifted to the left causing IJV compression (I landed on the right side of my face then bounced onto the left).
ICA compression is more serious because, very rarely, it can lead to a stroke. Since you’ve already had a couple of serious complications w/ your ICA, getting that appt. w/ Dr. Costantino sooner than later is a good plan.
It’s good that you’ve got a consultation with Dr Costantino, hopefully he’ll be able to tell enough from your images- it’s hard to say accurately for us being non-professionals, but the styloid looks to me as if it could be angled inwards…I hope as @Isaiah_40_31 says you can get an appointment quite quickly with Dr C.
Huh. I chopped things up so I could get a view directly from the front. I do not like where that bone is at all. My guess is that it wasn’t pointing like that until recently. Now considering a follow up today to make sure they’re moving my appointment process along.
Follow up calls are a good idea. If your styloid is the white area resting on your ICA, then it’s no wonder you’re having the vascular symptoms you are. I’ve annotated your image & circled the internal carotid artery. The external carotid is to the left of it. The location & position of your styloid is still unclear to me, though it looks like it could be lying directly on the ICA.
I’m a bit baffled as to how the tech caught a 2 mm anuerysm in my carotid canal with this image, but not the chunk of bone crossing my artery. I guess it’s hard to look for things you don’t know can go wrong.
I got an appointment with Dr. Constantine, but it’s not until April 24. I sent photos to my Dr. with a request that someone review the images again to confirm whether my carotid artery was potentially being compressed, and they messaged back telling me to try to avoid positions that cause symptoms. That’s it. My therapist has me on a safety plan because my sleep has been disrupted every night for the last four months, leaving me sleeping fitfully for a few hours sitting up for sometimes weeks at a time, and sometimes that’s left me in an unsafe place, and they’re telling me to avoid laying down, turning my head, or leaning back in a chair for another two months before getting any more help and leaving it at that?
There has to be more I can do to move this faster. I can make it through one more night in Hell, right? Just one night at a time, and I’ll try calling more people tomorrow.
@lfrit If you didn’t ask to be put on a cancellation list for Dr. Costantino, you should call his ofc tomorrow & request that. Some of members have gotten appts moved to an earlier date that way.
Another thing that has helped some of members who had possible ICA compression is to purchase a soft neck collar & wear that during the day & while sleeping as it can help hold your head/neck in a more neutral position or at least serve as a reminder to keep your head out of provocative positions that increase symptoms. Amazon has a variety of styles (search “soft neck collar”) that aren’t too expensive.
Since your compression is ICA (which based on your symptoms is in pretty urgent need of treatment) vs IJV, you could make an appt w/ one of the other ES surgeons in NY who are on our list for a second (first) opinion as you may be able to get in sooner. I’d do a search for mention of each one on our forum to see what those who’ve seen them have to say. Dr. Costantino specializes more in the IJV decompression surgeries which are usually more complicated than those to decompress the ICA.
•Dr Yosef Krespi, Lenox Hill Hospital, Manhattan 212- 262- 2929 Yosef Krespi, MD | Northwell Health
•Dr Coniglio, Rochester, John U. Coniglio, MD | Rochester Regional Health
I’m sorry that you can’t get in earlier, as @Isaiah_40_31 says, you might be able to get a cancellation appointment…& I agree with trying a soft collar for now
