You have quite a posterior osteophyte(s) at C5/C6 level.
…
I’d guess that’s why you get problems with hands…
1 Like
@Sonoran_Sunset I had a chance to go through the axial slices of your CT scan and I’d suggest you to get an MRI of the neck as soon as possible and chat with an experienced neurosurgeon.
I’m not a doctor, but it seems you get some spinal canal compression, which might be the cause of at least some of your issues
4 Likes
I could not look into the CTs in detail as I have family visiting and I am so busy with work these days but I feel @GCD has handle on this for the most part and did a good job but I find a dangerous ICA compression which needs a prompt action which made me write this piece without fully studying the CT.
I do agree with GCD findings on the earlier CT. You appear to have Thyroid Superior Cornu rubbing your Carotid Artery but you also have the Hyoid bone in the bifurcation in the last CT showing a significant compression on your ICA in your latest CT from the hospital. No wonder you went to the ER. I do nor know what is causing this but your ICA appears to be significantly narrowed in that area compared to the old CT.
Red Arrow point to the Hyoid bone tip and the light blue arrow point to ICA. ICA is supposed to be round but appears to be compressed in an oval shape. This is dangerous and needs to be addressed as soon as possible to avoid stroke. You need to have dynamic Angiogram to determine if Thyroid Superior Cornu and Hyoid bone are dynamically compressing it from different angles. Your right ICA appears very narrowed in the bifurcation area. It could be that your Hyoid bone is moving back and forth causing temporary compression. Needs to be confirmed with dynamic angiogram
Here is the 3D rendering of it. ICA (light blue arrow) Hyoid (Red arrow) area of compression (Yellow)
2 Likes
@Sonoran_Sunset Thanks for uploading your prior CTA. It is actually extremely interesting to see the changes that happened between the 2 scans in about 1 week. This should prove very helpful moving forward with possible treatment.
As @KoolDude pointed out you have 2 points of impingement of the carotid artery (CA) on the right side. His images show serious blood flow reduction of the ICA that I did not catch.
You also have impingement of the CA on the left side as well as shown on your scan 6/25. So essentially you are popping the CA on both sides off and on the thyroid cartilage (TC).
I am going to repost my video below and have fixed the link. Look at the difference of the location of the CA relative to the TC on both left and right sides from 6/25 to 7/3.
CTA taken on 7/3
CTA right side taken on 6/25
CTA left side taken on 6/25
I found another case study that describes the symptoms that you may be feeling and also has very similar images to yours. https://www.jvascsurg.org/article/S0741-5214(08)00706-4/fulltext
3 Likes
Thank you all so much! I have not had to go to the ER, and my symptoms have been a little better, but I am a bit defeated at the moment. I received the report from the latest CT, and there were no clearly relevant findings. I think they likely didn’t look at my veins and arteries because of how it was ordered. Apparently, she ordered a soft tissue head/neck CT to look at my lymph nodes. Then we added the Eagle’s Syndrome rule-out note.
I went to my migraine neurologist yesterday (before the report was completed), and she basically said she couldn’t look at the images I brought because she wouldn’t know what to look for. She gave me nerve blocks in 3 or 4 locations to try to help with the pain. It really didn’t do much. She suggested getting on a cancellation list for the main office, but when I talked to the front desk, they said they didn’t have one. I scheduled with my endocrinologist for next Tuesday since every CT report mentions my thyroid. They also tend to listen to me.
This is the report:
NDICATION: Enlarged lymph nodes. Right jaw and neck pain. Assess for Eagle syndrome.
COMPARISON: None.
TECHNIQUE: 2.5 mm multislice sections were obtained through the neck pre and post intravenous contrast administration. 1.25 mm reconstructed images and multiplanar reformatted images were obtained. CT scan done according to ALARA (As Low As Reasonably Achievable).
CONTRAST: 100 mL of Omnipaque (350 mgI/mL) single-use vial was administered IV with 0 mL discarded.
Prior known CT or cardiac nuclear medicine studies performed in the last 12 months: 0
FINDINGS:
Multiple thyroid nodules are noted, largest in the left lobe appears heterogeneous and measures up to 3 cm. There is no evidence of a laryngeal mass. The epiglottis appears normal. Extensive dental artifacts degrade evaluation. No hyperenhancing mass lesion is identified along the mucosal surfaces of the aerodigestive tract. There is no abnormal thickening of the platysma. The submandibular and parotid glands appear unremarkable. There is a parapharyngeal course of the left carotid bifurcation and internal carotid artery. No fluid collection is noted. Each styloid process measures 2 cm in length which is normal. No pathologically enlarged or suspicious appearing cervical lymph nodes are noted. Mild levoscoliosis is centered in the upper thoracic region. Mild spondylosis appears to be present in the spine. Each TMJ appears unremarkable.
IMPRESSION:
-
No mass, abscess, acute inflammation or lymphadenopathy is noted in the neck.
-
Multinodular thyroid is noted with the largest nodule in the left lobe measuring up to 3 cm. Recommend correlation with thyroid ultrasound.
-
Normal length of each styloid process. The right styloid process appears to slightly contact the right internal jugular vein without compression present.
The fact that nothing significant was noted about your vascular issues isn’t surprising because it often requires a dynamic CTA/MRA scan, angiogram or ultrasound for the compression to be visible. Most people who have vascular compression don’t have it significantly when the head is in neutral position (i.e. lying supine, facing the ceiling). It’s when the scan shows the vascular tissues w/ the head in various positions that the compression problems show up.
Also, don’t let the comment about your styloids being normal length put you off. Remember that there are other features of the styloids (i.e. thickness, angle of growth, curve, how twisted or pointed they are) that can cause problems when elongation is absent. There was also no comment about calcification on your stylohyoid ligaments & you do have some lower down on your s-h ligaments which may also be contributing to your symptoms.
1 Like
Lots of members do seem to have thyroid nodules as well, I’ve never read any research papers that show a link but just what we’ve noticed on here…It would be interesting to see the images, as @Isaiah_40_31 says, there are other factors as well as styloid length which can cause symptoms. Also as @Isaiah_40_31 said any compression of blood vessels doesn’t always show because of the head position on the CT- if there’s contact with the IJV in that position as noted, there could be compression with different head positions…frustrating for you 
1 Like
@GCD and @KoolDude I want to thank you both again. I had to put my own health on hold the last week to support and care for my daughter. She has been fighting with her own unexplained and unusual issue (current hypothesis is a prolactinoma).
I am going to see my endocrinologist tomorrow. I am going to take some printouts of the images you made and ask about the thyroid cartilage and hopefully get her to at least rule out the thyroid nodules.
What you both see seems very concerning. Any ideas on how I can get a doctor to see it as serious? Is there 1 image that is glaringly obvious to someone with even basic medical training? I can’t seem to get a doctor who is willing to even look at my images. If I am able to, I would like to highlight the clearest one.
I think it is interesting that other members have thyroid nodules in common. I always suspected they were related to some other conditions I have that seem to all relate in some way. I have lipedema (adipose tissue disorder) and hypermobility syndrome. I feel like all my connective tissues are faulty and/or nodular.
@Sonoran_Sunset you are welcome and I think thanks to @GCD who spotted this the first time and demanded that you also provide the CT from the hospital which I thought was concerning because if they were correlating your symptoms to images we saw, they would have come to the same conclusion. I am surprised they miss it and I was concerned that you might be getting another temporary compression of the ICA since you were not feeling well when we did this analysis. What you experienced that day that you went to ER is consistent with ICA irritation or compression (see the screenshot below for ICA irritation and compression symptoms).
Source : You can find this in the appendix section of this study : https://emergeortho.com/wp-content/uploads/2018/04/1-s2.0-S2468781220301399-main-2.pdf
Finally this won’t be easily found unless a dynamic angiogram test of some sort is done in different neck position to catch the hyoid & calcified Thryroid cartiliage as they can dynamically move. You need an ENT that is familiar with this type of Hyoid/TC compression of ICA.
There is one expert on this issue on this forum (@CJsBattle - a fellow Canadian) who suffered from similar hyoid issue and has extensively studied it. @CJsBattle is currently recovering from a recent surgery (July 18th) where his hyoid bones were resected so he might not be feeling well enough to offer help at the moment but I would highly recommend that you connect with him as he can point to the best way to seek help and from whom for this issue as soon as he is able to do that.
2 Likes
@Sonoran_Sunset To answer the question you asked, I think @GDC did a good 3D rendering which shows images of interest and can easily be seen but I know some doctors prefer raw CT images as opposed to 3D ones so I compiled the slices that show the same thing in raw CT images in order to show any ENT doctor to pursue a further imaging. I think the CT on June 26th shows the compression of ICA but the recent one also shows different position of both Hyoid and TC Superior Cornu.Not a doctor but I think You need to address the right Hyoid Cornu first since it poses danger and could potentially cause strokes given it is relative position to right ICA. Then they can proceed to address the calcified TC Superior cornu which poses potential danger given its proximity to the CCA.
Here is the recent CT (July 3rd, 2023) : First Axial image shows right hyoid tip (Red arrow) located around the bifurcation of the right Carotid artery close to External Carotid Artery (ECA) ( Green arrow) but far from the Internal Carotid Artery (ICA) (Light blue arrow). No compression is visible on the right ICA and right ICA looks round as it is supposed to be. Second image is bit lower and shows the interaction between Common Carotid Artery (CCA - Joined ECA & ICA) (Red arrow) and Thyroid Cartilage - Superior Cornu (TC) (Blue Arrow). Right CCA appears to be slightly pressed by right TC tip anteriorly (Front - note the change of position of the TC tip on June 26th images below as it moved to posterior location). No meaningful compression on either ICA or CCA is visible on this CT.
Here is ER CT (June 26th, 2023) : First 2 images - Axial & Coronal show right Hyoid bone (Red arrow) in bifurcation potentially compressing your right ICA (Light blue arrow) dynamically. You can see the in axial image the round shaped left ICA and compare it with the right ICA. ECA (Green arrow) appears normal. This could be why you were in the ER to begin with. It is important to note this is not visible in the latest CT (July 3rd 2023) confirming the dynamic nature of your compression.
Second axial images are bit lower and shows the interaction between CCA (Red arrow) and TC (Blue arrow). You can see the TC is located posterior (Back) to the right CCA ( this is interesting as @GDC noted in his earlier report when compared to the recent CT which shows a location anterior to the right CCA). Left CCA appears to be in touching position with left TC tip.
Question, did you do some neck stretching or neck physio after ER visit? The TC tip changes of position (from Posterior to Anterior of right CCA in a week timeframe) between the 2 CT scans is interesting if it happened on its own without intervention.
Hope this helps with images of interest. Don’t give up. Fight for your health. No one will do it for you. Good luck.
3 Likes
I’m sorry to hear that your daughter is also having health issues. As a parent I know you will sacrifice yourself to put them first, but please try to make your health a priority too!
I have been thinking about your scans almost everyday since you joined the forum and started sharing your experience with us. I was looking for someone in your area that would be an expert in this situation. I didn’t want to suggest a doc I was unsure of, but then @BlacknBlueSaint mentioned she had been referred to Dr. Lawton at the Barrow Neurological Institute. They are located in AZ. Before having my pre surgical testing, he was one of the docs on my short list.
Like @KoolDude mentioned, the type of testing you need to do is called a Dynamic Angiogram. This should be able to show the compression from the hyoid bone and possibly the thyroid cartilage. This type of scan requires specialized equipment you will only find in a hospital and a vascular surgeon who knows how administer it. So it’s not available at just any hospital.
I had this procedure performed by Dr. Patsalides in NY, but @BlacknBlueSaint said there is an endovascular surgeon who had contacted her for the procedure at the Barrow Neurological Institute that does the same procedure. I’m sure she will share the name with you.
Once they confirm the site of the stenosis, it’s probably going to take a neurosurgeon and specialized ENT to work together to do a resection of the hyoid bone and possibly the thyroid cartilage at the same time. But that will be discussed down the line with your surgeon, if that is what is recommended.
Don’t rely on your MD or specialists to even know this procedure exists (even neurologists). My father in law is an MD and he thinks I was crazy to undergo the dynamic angiogram and then subsequent styloidectomy. I have offered to show him my scans, but he won’t look at them.
So the short list is:
-
Call Barrow Neurological Institute (602) 406-3181
-
Tell them you have a CT angiogram showing your internal carotid artery is being compressed by your hyoid bone and you have been to the ER because of it. (You can tell the surgeons later about the thyroid cartilage)
-
Dr. Lawton may have a long wait list or may not be the surgeon specialized to deal with your type of problem, so they will probably recommend seeing the endovascular surgeon that @BlacknBlueSaint was recommended.
-
Either he/she will see enough from the 2 CTAs or recommend performing the dynamic angiogram
Don’t waste time seeing other doctors to refer you. They will schedule you for a consult without one since you have those CTAs and if you need a referral later down the line you can get it.
3 Likes
Thank you @GCD. That is so kind. You are right about MDs not knowing. My endocrinologist was very concerned at my appointment and worked me in for an ultrasound. At least she ruled out the thyroid nodules.
Since the CT report doesn’t say compression, just “touching,” do you think I can say that?
1 Like
Yes, I would. The person you speak to is just going to be some intake front desk person who takes all your information down and the schedules you a consult.
Once you get to the consult that’s when you can show them the really nice pictures that @KoolDude made.
3 Likes
I made all the calls today:
Dr. Nakaji at Banner needs a physician to fax them my patient records, CT reports, and images to their referral coordinator. They will look at it and decide if they might take the case. She said Dr. Nakaji has only been taking brain surgeries recently, but they might have another doctor who would take it.
Dr. Lawton at Barrow also requires a direct referral from a physician, but they wouldn’t give me any details.
Dr. Milligan’s office said that he wouldn’t see me for what I described (I said I had Potential Eagle Syndrome with my styloid touching my internal jugular vein and my hyoid compressing my carotid artery).
I called the Mayo Clinic because they are in-network for me. Their scheduler had a very difficult time trying to find anyone. She ended up scheduling me with a Dr. Zimmerman on 8/8/.
I will also put a portal request into my migraine neuro to see if she will refer me to Nakaji or Barrow. Barrow has an ENT and Skull Base department that could be an option if Dr. Lawton isn’t taking patients.
My endocrinologist was great and concerned. She got me in for an immediate thyroid ultrasound but found nothing related to my thyroid other than the known nodules. She said the large one (3 cm) had maintained the same volume but changed dimensions/shape since last December. At least I ruled that out.
2 Likes
@KoolDude, I forgot to answer your last question. The answer is yes; I think I was stretching it. One thing that made it feel better was to look up to the sky with my jaw clenched/closed, stretch the SCM, then open my mouth/drop my jaw and slowly close it again. That’s it, though. I am hypermobile and I have things slip in and out of position all the time.
1 Like
It could be that when you extend your neck your Carotid artery moves away from the Hyoid + Thyroid cartilage Superior Cornu area. Interesting how you were able to move TC tip around the CCA. Hypermobility has an advantage in this case.
3 Likes
I’m so sorry you’re going through all that! I haven’t had my appointment with Dr. Lawton yet, so I don’t have much info to offer yet. So far I sent him my referral (but you don’t need one, you can self refer as well) and he reviewed my case and ordered a dynamic angiogram from Dr. Albuquerque who is an endovascular surgeon, also at Barrow Neurological Institute. I’m in the process of trying to get that scheduled now. I will have to travel there to do all that, so they are trying to get my imaging scheduled one day, then Dr. Lawton consult the next, and maybe even get my surgery scheduled the next day after that. Not sure if they will be able to schedule my surgery until after my angiogram, though, because they really don’t know what kind of surgery it will be at this point.
In the meantime I’ve seen an ENT in my area who also wants to consult with a vascular surgeon and see what kind of testing he should do to see what is causing my compression. I’m waiting on that because if they want to order the same test as Dr. Lawton then I would probably just do that part up here and then send the results to Dr. Lawton. I have my appointment with the vascular surgeon here on Monday, so I will go from there.
With Dr. Lawton’s office, you might need to be very persistent and call regularly to keep things moving along. The front office staff hasn’t been great but the back office staff has been wonderful. Let me know if you need any help or advice in getting things moving along with them.
5 Likes
@KoolDude the hyoid/thyroid cartilage apparatus is hanging mostly freely suspended by muscles/ligaments, and depending on various parameters, including muscular tone, amount of fat around the structures, can “migrate” and establish new position within the limits of ligaments.
When you swallow, you can feel it moving up, down, and then returning to the “base” position. A problem develops when the muscles around (including SCM) become stiff, preventing free movement of hyoid/thyroid cartilage.
2 Likes
Thank you!
First, you have clearly done some hard work and I hope you get everything scheduled soon.
I have actually seen Dr. Albuquerque before. He did my brain angiogram in 2015(ish). He was nice but I mostly worked with his med student or assistant Dr. (not sure what he was). When I called Barrow today they said they had to have a referral from my doctor even if my insurance doesn’t require one. Do you have a phone number I could call to do a self-referral?
2 Likes