I got my CT with contrast done today.
Got the pictures on a disc and have been setting it up as a 3D modell, also been looking through tons of pictures to compare.
What im thinking out of that is that my i think my styloid is normal, but i may have a calcified ligament on each side. Also i think the C1 might be compressing the arterys.
I am still waiting for the doctors feedback, but since i am 99% sure they will just dismiss it all, i want to have some ideas of what im looking at so i can ask about it and as for a referal to another hospital that is more specialized.
What do you guys think? In a non-medical opinion of course.
Is calcified ligament acknowleged as a problem or not?
Also, any idea what might be going on in my left shoulder? TOS?
Shoulders; front view and both right and left for refrence. Left side is very different from right side. I have read some people with EDS and ES also have problems with compression in shoulder… TOS maybe.
It does look like the bloodflow on that site is not as good as the other.
Well, in my non-medical opinion, your neck seems very straight (loss of cervical lordosis aka military neck).
I’d guess you have some stiffness in thoracic part of the spine too? E.g. how easy for you is to do the cat-cow exercise as in this youtube video? 10 Best Back Pain Exercises Ever Created-Stretches & Strengthening - YouTube
Re styloids, vascular impingement… there might be slight compressions, but they don’t look very extreme to me…
But if you have cervical instability, this can be very dynamic situation, especially when it comes to vertebrobasilar arteries/veins going through the transverse foramenae. I guess the arteries leaving the spine at C1 level might get compressed at C1/C2 or atlantooccipital level.
On the left side of Hyoid bone is also close to the left carotid artery but bit far compared to the right. Not sure if it is touching when you turn your head or move it.
As far as the Jugular Veins are concerned, Yes, the C1 Transverse process is compressing them but I doubt they are the cause of the stroke like episodes. They cause head pressure and vision issues by raising the intracranial pressure. These are Veins not Arteries. Arteries supply blood to brain where Veins return blood from the Brain back to the heart. Artery dissection or occlusion is an emergency as the blood cutoff from the brain is very damaging.
Finally, I need you to post more images to confirm this issue. Can you post Coronal and Axial images of the neck. Similar to the ones posted below. I found these ones in the internet and you can see the horn of the Hyoid bone in the middle of Carotid Bifurcation.
On the last note, it is late here in Canada and I have not had much time to look all the images in detail but this are my suspicions based on your symptoms NOT DIAGNOSES as I am not licensed radiologist. This is to help you to take it back to the Radiologists in Norway and have them verify it. Also, demand to do DYNAMIC Angiogram, so they can see the Hyoid bone compression if any.
I see what looks like the transverse processes of C-1 compressing your jugular veins (the right looks worse than the left to me), & can understand what KoolDude mentioned regarding possible carotid compression by the greater horn(s) of the hyoid bone. I also totally agree w/ vdm about the loss of the lordotic curvature in your neck. That alone can cause all sorts of shoulder problems, head & neck pain ,but when you add the vascular compression, the symptoms can be really terrible.
I do see that your right styloid is very short, but your left one looks a bit long & perhaps a bit thick which can also create problems. Your right styloid even though short is forked. It doesn’t look like the little points are causing a problem, but when your head is in certain positions, they could be contributing to the compression on your right IJV. Can’t tell for sure though.
I don’t see any calcification of your stylohyoid ligaments in the images you sent. The ligaments attach to the lesser horns of the hyoid bone & would be visible either there or between those points & the styloid processes if there was any calcification on the ligaments. I’m including some images below to help you understand what I mean. The picture w/ the calcified ligaments has one that is excessively calcified & one that is what is more commonly seen.
“The hyoid bone lies in close proximity to the carotid artery bifurcation, and anatomic variants have been implicated in carotid compression, stenosis, dissection, and pseudoaneurysm”
See the black circle below, for the right, it lies close bifurcation, for left it is below the bifurcation.
The other thing that makes me suspicious of this hyoid bone involvement is the tongue atrophy and fasciculation you mentioned that you have had after the last episode. The tongue is controlled by the hypoglossal nerve which passes close to the carotid bifurcation and since the hyoid bone is close to that , it is conceivable that not only head-turning compresses the carotid artery, it could also compress the hypoglossal nerve thereby causing tongue issues.
After one big episode i had Tongue fasciculations and tongue athropy for a long time after.
I got this pic from the internet to show you how close it is to your tongue nerve
I think there is good grounds that this might need to be investigated more to rule out close contacts between hyoid bone and right carotid artery given your images and symptoms. I will also recommend that you ask you doctors blood thinners (anticoagulation medicine) as that might help alleviate stroke incidences according to the few papers about this condition. Also if you can use soft neck collar to make sure that your neck movement is limited since it is triggering these episodes will be helpful while wait for your diagnoses which might take a time given the complexity of this rare condition.
I agree with what the others have said, but I do think there could be some calcification on the ligaments arpund the jaw area both sides. I’m sorry, I’m a technophobe so can’t mark it in the images like the others have, unless it’s artefacts…but lots of advice & pointers from the others as to what to ask a radiologist about…
@Isaiah_40_31 Thanks but I guess I am in little too old now for medical school, late forties and pushing fifty. The brain does not get sharper from here onwards.
Yet another interesting study with carotid entrapment by the Hyoid bone. Might contain some surgery pictures so little warning here. The following images are from the study and see how similar your images on the Hyoid bone look to this one. There is also video animation in the study link which you can download and watch how the right horn of the hyoid bone is in between the two branches of the carotid (ICA & ECA)
Fig 1Computed tomography angiography of the neck. A , Multiplanar reconstruction (MPR) demonstrates the interposition of the right cornu of the hyoid bone between the right carotid arteries. The arrow indicates the right internal carotid artery. B , Anteroposterior and (C) lateral views of a three-dimensional reconstruction show the carotid artery and the cartilaginous and bony structures of the larynx and an osseous background. Note the low carotid bifurcation on the right side at C 4/5. C , The arrow points at the interposition of the right cornu of the hyoid bone between the right carotid artery.
Wow, what an amazing feedback. @KoolDude You are an absolute legend! I would never have seen/thought of that.
Thank you everyone for your time and effort, specially kooldude!
I have had a long day with the kids, and have been having episodes on and off tonight, so i dont dare sit up by the pc atm.
Holidays are specially hard with two kids with special needs at home, but oh so precious.
I will sit down and find some more pictures, and write a litte better feedback as soon as i get a little more calm days, maybe tomorrow or the day after.
Take care everyone
@saxine, you are more than welcome. I know I put too much stuff here since I had the time. Please take time to digest all of these, specially the last study I posted. I am afraid, if they do not see any stenosis (narrowing) or dissection of the artery or occlusion, they might say, there is nothing wrong with it. Insist that it be investigated. The 61 year old in the last study had mild stenosis after TIA but felt better after resection of the horn that was offending.
I hope you find a caring vascular surgeon who will listen and look deep. Please show them some of these studies as well. They tend to heed science literature than patient’s anecdotal evidence. Also, if you can post the frontal Hyoid bone and Carotid images will be helpful in seeing if the right horn is in the middle of right carotid bifurcation as that might cause TIAs if the neck is moved.
We like to say we’re only as old as we feel & if we don’t feel old, then we aren’t old. However, I do concur that feeling is not always the same as reality. The brain does shrink w/ age & so does its ability to retain information. I understand your reason for not taking further advanced education. Perhaps you could get some sort of certification to do consulting instead.
Good one. Not to mention Eagle Syndrome which is putting me in downward slope much faster than I would have been otherwise. I wish you and your family the best of holidays Isaiah, You might not know this but reading a lot of your posts along with Jules before joining here helped me tremendously.
Thank you for that info, KoolDude. I’m happy to know that what we’ve posted helped you. You are a tremendous asset to our forum. We’re very thankful you’re here & providing information that we can learn from as well.
If/when you have ES surgery & get your IJV & nerves decompressed, I believe a lot of what you feel you’ve lost will return. Take heart!
Happy Holidays to you. I hope you’re able to enjoy the holidays to the greatest possible extent w/ family or friends.
