Hi, I’m Cristina, Brazilian, I was recently diagnosed with Eagle. My symptoms started with pain in my throat, ear and tongue. Then I started to feel as if there was something in my throat. Then dysphagia. Currently, I started to have high blood pressure, which I am controlling with medication and less salt. Lastly, and together with high blood pressure, I have episodes of tachycardia, mainly in the morning, when getting out of bed. I have already had a three-dimensional CT scan, which I am awaiting the results of and have made an appointment with a head and neck doctor. My diagnosis was made based on the symptoms and a panoramic x-ray of the jaw.
My question is the following: what is the main difference between the symptoms of vascular compression and vagus nerve compression?
I think from reading many members’ experiences on here that blood pressure issues & tachycardia are more often from vagus nerve compression/ irritation, but you’re right that if the carotid artery sheath is affected by the styloids this can cause heart arrythmias too. Often if the carotid artery is compressed you’ll get dizziness, fainting, headaches too…
@GrnyAny did this really helpful post about her symptoms:
Successful Surgery for severe Vagus Nerve Compression - General / Eagle Syndrome Stories - Living with Eagle
And there’s some info in the Newbies Guide Section about symptoms & possible causes:
ES Information: Common Symptoms And Possible Explanations For Them - Welcome / Newbies Guide to Eagle Syndrome - Living with Eagle
The best way to see if the blood vessels are affected is with a CT with contrast, but if you’ve just had a CT that would mean exposure to more radiation, which isn’t ideal. A FIESTA MRI can show nerves at the skull base, but they’re not done in many places, we’ve had some discussions about that & very few members have had them.
Unfortunately for alot of us the only way to see which symptoms are being caused by what is to surgery, unfortunately! I’m sorry I can’t be more helpful, let us know what the CT shows when you get the results 
Thanks for the response. Do you know if an ultrasound of the neck would help?
Before my CTA where the neuroradiologist indicated a trapped IJV the only person who was listening to me was my GP and the ultrasound technician whose supervisor allowed her to experiment. I will give you exactly what they said. By the way, if anyone could comment on the “official” measurements I would be grateful. During the experimental test I used a technique that I had heard about with the vagus nerve. Humming. You could see things open up as I did it. Technician said it might work to hum when I was having some kind of what I call “fit” . I call it that but it is not epileptic in nature or the kind I saw of an Osborne patient whose body was jerking. It is just what I call it when my body is staging a strong rebellion against what is being inflicted on it.
Right Carotid Artery:
ICA Proximal PSV: 0.43 m/s
ICA Proximal EDV: 0.15 m/s
ICA Mid PSV: 0.62 m/s
ICA Mid EDV: 0.26 m/s
ICA Distal PSV: 0.47 m/s
ICA Distal EDV: 0.18 m/s
ICA/CCA ratio: 1.18
ICA Plaque: No plaque noted.
Vertebral: Antegrade
Left Carotid Artery:
ICA Proximal PSV: 0.63 m/s
ICA Proximal EDV: 0.22 m/s
ICA Mid PSV: 0.61 m/s
ICA Mid EDV: 0.24 m/s
ICA Distal PSV: 0.68 m/s
ICA Distal EDV: 0.30 m/s
ICA/CCA ratio: 1.16
ICA Plaque: No plaque noted.
Vertebral: Antegrade
Other: Of note, there are certain images labeled as with and without
compression. After discussion with the sonographer, this was labeled
in error and no compression was done. The sonographer placed the
patients head in different positions while scanning the jugular vein
to assess for possible eagle syndrome. There is positional
compression of the jugular vein by adjacent soft tissues. Upon review
of comparison MRI neck 4/26/2024, the neck soft tissues were
unremarkable.
After this test, and an MRI that indicated the same thing, I kept saying to the Medical community that I needed positional testing. It is quite possible that those styloids are pushing on something that is then compressing my ICA or my IJV or it was directly doing it, etc. I was met with basically the equivalent of blank stares. How could I see it when they couldn’t? Well, I guess Dr. Google. At least the neuroradiologist saw it. But even then the ENT surgeon and the Neurovascular Surgeon couldn’t comprehend the issue.
I have been pushing for positional testing since day 1 of the dentist finding this issue. He had told me to go home and Google it. It became clear the same day there is a possible positional issue with these sticks in my neck. I am still flabbergasted that people who have gone to Med School and have had to study anatomy just don’t get it.
P.S. I have a known vagus nerve issue. Years ago I passed out and my heart stopped beating on the tilt table test. But it didn’t do it on a recent test. Tilt table test can be hit or miss. You can try to provoke with medication. The last test didn’t try to provoke. The first one didn’t need to provoke it. I was scheduled for another one but postponed it.
Thank you for your testimony. Have you already had surgery??
No surgery for me yet. I am terrified at the incompetence i have been subjected to and finding hard to trust anything or anyone in the medical profession. I have tried to call Hepworth but no response so far. I am leaning toward him but am going to check out dr old at ohio state university since it is within driving distance.
There are some people in this world that dont like to upset the apple cart. I am sure it is harder for those kind of people. I dont mind aggressively pursuing the issue and i dont mind saying I refuse to accept the note in my file that says i dont have Eagle syndrome when I am clearly symptomatic and clearly have elongated styloids.
An ultrasound of your internal jugular veins & internal carotid arteries might be helpful. What is measured is the rate of blood flow through the veins/arteries at various points in the neck. This can be done w/ the head in neutral position (facing the ceiling, turned left or right & looking up or down). You need a technician who knows the right way to do this to measure the rate of the blood flow at each point. It seems there aren’t many ultrasound techs in the US who know how to do this so you may have a hard time finding someone in your country, but it’s certainly worth asking. You would also need to see a doctor who understands the significance of the numbers that are recorded at each vascular point in the ultrasound to determine if you have any vascular compression.
It’s very distressing. I spoke to several doctors, who I am friends with, none of them knew ES. I think there must be an underdiagnosis of the disease, since elongated styloids are not that uncommon. Certainly many people suffer without finding a solution. Doctors need to know more about the syndrome.
There is the problem. It can be done. I had my neck in all kinds of positions including when i was leaning down. I was watching the test and technician would point stuff out to me. Jugular closed etc. But by the time it got to the radiologist it was disregarded.
I totally understand that scenario, @JugularEagle. I had my first US done by an interventional radiologist who did it himself & told me everything was fine. SHEESH!
@Crisbr78 - We have one doctor on our list for your country. I don’t know if it’s possible for you to see him. He has been mentioned on our forum but not for some time.
•Dr. Romualdo Tiago, Clínica de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, R. Borges Lagoa, 913 - cj 96-97 - Vila Clementino, São Paulo - SP, 04038-034, Brazil +55 11 5081-5883
I can relate to this. Most of us go through so much trauma, pain, and mental anguish that I can see people just wanting to put it behind them!
@harrisonboy has really been through the ringer but I hope he updates after his surgery which I think is next week with Hepworth.
This doctor works in São Paulo, it is far from where I am. I consulted with a head and neck surgeon in my area. He asked me for an ultrasound of the neck and a cardiological evaluation. Tkanks!