@Snapple2020 Thanks, I will need to go through these images a bit deeply later this evening but by briefly skimming through them, I found the right vertebral artery (VA) to have somewhat abnormal course as it enters the skull and join the left VA to form the basilar artery (BA). the right VA appears to be very close (almost touching distance) to the skull base bone where the C1 joins the skull. I wonder when you rotate your head/neck or hyper-extend it to the right, that the right VA is getting compressed by this bone. This can’t be answered with static CT like this one and we can only speculate at this point but one of the reasons why it is good idea to do a dynamic Angiogram to see if it is intermittently being compressed. This definitely calls for further investigation. I am not a radiologist or doctor but to my untrained eyes, It definitely looks suspicious to me.
I could not find any issues with the right Subclavian artery which appears to be normal in size and no dissection/compression/irregularity could be found.
Here is coronal view of right VA (red arrow) and left VA (blue arrow) and the bone in question (yellow arrow). With EDS, I am afraid the right VA is vulnerable to compression by nearby bone with hyperextension/neck movements (this hypothesis need to be tested).
Just for comparison here is my right VA (red arrow) and left VA (blue arrow) and the bone in question (yellow arrow). You can see there is fair amount of distance between the right VA and the bone.
Snapple, I hope that you feel better soon, such a long, drawn out journey for you. Sending you & hug & praying you’ll get the right scans & see the right doctors
Thanks Kooldude for your input. I look forward to any further details later when you have time to review more in depth. Keep in mind this imaging is one year old and my arm/bracial plexus symptoms have significantly worsened since then.
I can definitely see the difference when compared to yours. In 8/2018 MRI, there was a “Note is made of a dominant left vertebral artery.”
A few weeks ago, I hyper-extended to the right and I almost blacked out. When I turned over in bed to the left and moved to get out of bed, similar movement…not quite hyper-extending my neck to right, I got pretty dizzy. Im been trying to be more aware of what movements trigger the dizziness. Movement to the right definately feels restricted compared to left.
When I was at the Vestibular PT this past week, while laying down flat, she allowed the head cradle to drop down suddenly …(kinda like a trap door) and it hurt like hell, my head dropped more to the right and back. I can’t hold my head up (reason I dont do sit ups) without support in that position…I had to hurry and grab my head to support it. Im not sure why she would do such a maneuver when someone has neck instability. Duh???
@Snapple2020 I have looked into the CT much more deeply this time but I found something that is significant in terms of your right sided symptoms, mainly the presyncope/dizziness but it needs to be verified with dynamic angiogram that you are about to go under. Don’t know if these have been found when the radiologist looked into this CT Angio but I found 4 pieces of what appears to be calcifications along the Carotid Artery (primarily External Carotid Artery).I do not know whether these fragments are the remnants of the removed Styloid/stylohyoid ligaments (not sure what was removed) or whether they are naturally formed calcifications. Regardless, they are of great significance if they prove to be compressing/irritating either the ECA or the ICA intermittently when you move your head/neck or hyper-extend it or in a car driving on bumpy road. According to the literature, irritation or compression of the ECA can also cause weaknesses on the Arms along with dizziness and presyncope (see the documents at the bottom). This is all relevant in your case but needs to be established with Dynamic Angiogram. I also found that the ECA signal to be bit weaker in around the 3rd piece of the calcified fragment which lies in between the branches of the ICA & ECA (not sure how significance of it is). I am not sure if this is the only culprit as your EDS also put you at risk of other intermittent compression of other vessels but felt the need to report it anyway.
First piece of the four calcifications (cyan arrow) sits on top of jugular vein (blue arrow). It is important to note that It resembles the remaining styloid but this is not the remnant of the removed styloid. This is the 1st piece of 4 calcifications.
This is the 2nd piece of the calcification (cyan arrow) and is resting against the External Carotid Artery (ECA) (red arrow) potentially irritating it.
This is the 3rd piece of the calcification (cyan arrow) and lies in between the External Carotid Artery (ECA) (red arrow) and Internal Carotid Artery (ICA) (yellow arrow). It can potentially mess with either of them. Also important to note that ECA signal attenuates here
Kool Dude,
Thanks again for your input! You have given me alot of food for thought. I have long wondered and others (as well) whom had their styloids and calcified ligaments removed by a CA doctor, whether ALL the calcifications were removed during ES surgery? One patient, in particular was found to have considerable styloid left untouched and told it was bone regrowth (in less than a year?) Many of us suspect not alot of focus taken on the calcification being removed during surgery or consideration of possible IJV compression. Because of this, I asked TMJ and oral surgeon last year to take a look at CBCT and see if styloids taken at skull base on both sides. It appeared mine were removed but not alot of focus on any possible small pieces of calcifications at the time. Docs ES operative reports lack the detail I would like to see with regards to removal of calcifications of the ligaments. Not much more than about 3.5 cm removed on right side. Ive got to wonder now about the possibility this doc only took out calcified pieces that were easily accessible and visible. I certainly have most all the imaging done which is considerable since 2015 that could be reviewed. I had both sides done externally in 2020.
Also, have wondered if our bodies have tendency to lay down calcifications in general, once ES surgery done, will they return?
It happens I see Oral Facial doc at academic setting tomorrow that has been on the books for months, I had planned on taking CBCT done the past years ie: tooth extraction and implant process. I will take all my scans and if appropriate speak to him about this. Never have met him before but is well regarded in the local EDS community. I have not yet got the orders from neurosurgeon for the dynamic imaging. Since the appt was Thursday, I figured Id give him a couple days as i think he wanted a consult report to go with it. Ill start stepping up the request so I can get the scans this week.
I certainly do have many of the possible symptoms - intense occipital headaches, jaw, etc It is why I have resorted to botox injections in jaw, occipital and temples. Its been a little hard to tease out what is occipital/neck issues vs TMJ vs EDS related arm/hand ligament repairs/scar tissue the past decade.
@Snapple2020 I can only speculate since I do not have evidence but I think these are remnants of either the removed styloid or calcified stylohyoid ligament. It is highly unlikely that your body will produce 4 pieces of calcifications in less than a year. If that was true, you should have them grown by now to double of their original sizes at that rate since the CT itself is one year old but I think that is highly unlikely. Either Samji left it because it was too risky given the close proximity to Carotid artery branches or he did not see them at all. Either way, they need to be addressed. Don’t even know if they are irritating nerves as well since you have so much pain on that side. I am also looking forward to seeing the result of the dynamic blood-flow test since other intermittent vessel compressions can happen with EDS.
LOL. Kool dude. Yeah didn’t think regrowth could happen that quickly. The patient I know of, had considerable styloid left in and had to seek another surgery for revision. Didn’t leave me with a warm & fuzzy feeling about what was done in my neck.
I honestly dont think ES Surgeon spends alot of time on these calcifications. Ive always wondered if these surgeons should be reviewing the CT scans at the time of surgery to make sure all the calcifications are removed rather than going in blind and just seeing what they find after they open you up. You would think if something was too risky to remove, there would be made mention of in the operative report?
I think every ES surgeon takes a different approach to removal of the calcified stylohyoid ligament. Often I think it can be segmented and not continuous. I could have sworn I was told mine was assumed to be continuous at least when reviewing the scan prior to surgery. In the case of some patients, they get the value of getting a pix of what was removed. Samji does not give you photo…and wont if you request one.
