The styloids do look long. If we assume the entire length of the whiteness is the styloid process, then they get into around 40mm. If we assume that the bits without a darker inside are just calcifications of the stylohyoid ligament, then it’s shorter. The left styloid process looks like it’s thicker. Without looking at any dynamic imaging, however, it’s hard to say anything about whether they are problematic per se. Right IJV looks pretty good all the way to the base in the CT from May. Perhaps head flexion could cause the SP to perturb ECA on either side but I don’t see any deformation as is, though it’s kind of blurry where the two pass each other. The left IJV’s got like a dark spot in the middle in axial view that may or may not indicate something about the contrast, and therefore any blood, not filling in there as quickly as the right. Assuming that whatever dots @Henrik mentioned have something to do with the stents (rather than CSF leak…?) the right transverse sinus is nice and visible. On the other hand, it’s hard to tell whether the left transverse sinus is communicating with the left sigmoid sinus at all. Not read on what the implications are off-hand. I’m sure this is noted in the reports.
No comment on any cranial nerves that may or may not be involved, nor on any hyoid-adjacent calcifications.
At a glance, thyroids look kind of asymmetric, though again, I’m unread on any implications off-hand. Generally, your daughter appears to be leaning towards the left in the CT machine, which could indicate some mild scoliosis lower down the spine. Definite loss of cervical spine lordosis, but it could be worse. Any MRIs you have on file could tell you a little more about whether there’s any bulging, herniation, discoloration, etc. Recommend PT as well, perhaps bring along a report from an orthopaedist who’ll comment on or order MRI imaging. May be difficult to coordinate, but I’m not familiar enough with PTs to know whether they know how to prevent injury in complex cases.
Styloid process length is ~39mm on the thicker left side, or ~31mm if we treat the bits without a dark inside as stylohyoid ligament calcification rather than styloid process elongation. Over the 30mm benchmark either way.
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Turning now to your specific concerns:
As @Henrik mentioned, there does appear to be some concerning tortuosity of the optic nerves. On sagittal view of either orbit, you can see the optic nerve (which is easy to spot), coursing down then up before piercing the eye ball. The idea here, IIRC, is that there’s a sheath that protects the optic nerve, much like the dura protects the brain, and inside that sheath is CSF, which in IIH, causes the sheath to stretch and distend. It’s probably worth going through the literature for a severity grade.
Also, it’s hard to be sure with the CT, but the sella turcica does look empty. In other words, the pituitary gland (aka hypophysis) appears to have been flattened by CSF pressure. Pituitary gland involution generally is normal, but definitely not in one’s twenties.
From my scant recollection of the few papers I’d skimmed, these two alone are pretty strong signs of intracranial pressure.
I don’t want to overwhelm you with too much or overload this thread, so feel free to poke at anything above, eg for references and evidence. If you want to try to figure it out yourself, I’ve sent you some resources that I hope you’re in a position to make use of. I’ll see if I can get around to narrating a screencast for you with just the above remarks in the next couple days to maybe get you started.
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