The reason why your symptoms are predominantly on your right is likely because your right styloid is compressing the ICA, which can radiate pain down the length of the artery. Exercising probably makes things worse because blood is getting pumped more strongly through the compressed ICA.
Not to scare you, but I definitely think it’s serious. Stylo-carotid syndrome can be dangerous, due to the risk of the styloid destroying the wall of the artery. That being said, you don’t seem to be presenting with any stroke-like symptoms it seems so I think you’re safe as of now. Glad you are meeting with the surgeon! Definitely want external approach as intraoral may not reach high enough up to decompress things
Getting the diagnose and surgery in my country will get some time and effort i think, ill keep you all updated. Another question, the right one looks like segnented or broken, it’s that a fracture?
I’m glad that you’ve found someone who has done the surgery before; we have had quite a few members who have had successful intra-oral surgeries, but in cases where the blood vessels are involved it would be much safer to have the external/ trans cervical method, & as @TML says you would need the styloid removed high up at the skull base to ease the IJV compression. It’s not always possible to tell if the styloid has been fractured, or if it’s a piece of calcified ligament at the end, some times it can grow continuously or there can be a small gap / segment like with yours. Ultimately it doesn’t make any difference with the diagnosis as long as all the calcified sections are removed.
In the Newbies Guide Section about surgery, we have a list of questions we suggest that members ask their doctor before surgery:
How many ES surgeries have they done and what was the success rate?
Whether they’re going to operate externally, or intraoral- through the mouth. Whilst some members have had successful surgeries with intraoral, external is better for seeing all the structures, to be able to remove more of the styloids, & also there’s less chance of infection.
You need to ask how much of the styloid he’ll remove- as much as possible is best- & anything left needs to be smoothed off. The piece needs to be removed too- some doctors have snapped it off & left it in! If the styloid is only shortened a bit it can still cause symptoms.
If your stylohyoid ligaments are calcified, then any calcified section needs to be removed too.
There’s usually swelling after surgery; you could ask if a drain’s put in to reduce swelling, or if steroids are prescribed. It’s not essential, but can help with recovery a bit.
Will it be a day case surgery or will you need to stay in?
Obviously ask the risks- we know from experience on here that temporary damage to the facial nerve is quite common, and also the hypoglossal nerve and the accessory nerve. These usually recovery very quickly but in some cases members have needed physiotherapy. There is also the risk of catching a blood vessel or having a stroke, but these are very rare.
Ask if the surgeon monitors the nerves- this should be done to see if there’s stress on the nerves to avoid damage as mentioned above.
What painkillers will be prescribed afterwards.
Ask about recovery- most doctors either down play it or are genuinely unaware of how long the recovery can take!
We have heard that occasionally doctors use surgical clips which are left in, it’s been suggested that these could interfere with chiropractic adjustments if needed post-surgery, so something to consider, and also we have now seen members who’ve been left in pain from the clips and needed further surgery to remove them, so do ask if they might be used.
@Deggui I don’t think it’s a fracture. I think you have an elongated styloid and the. The stylohyoid ligament coming off the tip has become calcified and the two structures are separated by that change in trajectory and just looks like a fracture. Essentially we are seeing where your styloid ends and your stylohyoid ligament calcification begins.
I know I was informed about the risk of increased symptoms with a molar extraction, but I still need to have this wisdom tooth removed since it is impacted and caused an infection some time ago, and I’m not sure if it currently has a chronic infection. Do you think that removing it might improve some symptoms due to reduced inflammation or compression in the area?
Is the styloid process definitely the cause of my problems? Or could it be this elongated without causing any symptoms?
I think the right one became more affected due to repeated oral infections on that side.
@Deggui put it this way - you are experiencing bizarre symptoms that most people do not experience. And you have a bone that is compressing your ICA that most people do not have. So I think it’s likely that the bizarre symptoms you are experiencing are due to your bizarre syndrome.
Well, I just came from an appointment with a maxillofacial surgeon who is also an ENT and stomatologist, and he has experience with Eagle syndrome. He told me that we need to remove the wisdom tooth, since many of my symptoms are more related to a dentigerous cyst. He palpated the styloid process from the outside and didn’t think that was the cause. He said we should first address the obvious issue, and then see what happens next.
It all went very quickly; he didn’t want to look at anything except the panoramic X-ray. The thing is, right now I don’t have the symptoms I mentioned — they seem to vary depending on my activity. Should I get a Doppler ultrasound?
If I don’t suffer from symptoms constantly, is it really necessary to remove the styloid process? Maybe a Doppler ultrasound would change the picture, I’m not sure.
I mean, structurally it seems there’s compression, but the only way to know for sure is with a Doppler ultrasound or a CT angiogram?
its not an easy decision for me to take but is also hard to get a surgeon suggesting the decision…
I’m getting a left styloidectomy next month due to IJV compression but also because my styloid is only 1mm from my ICA and my surgeon is worried about a future stroke. Your styloid is already in direct contact and compressing the ICA. The CT imaging proves the compression, an ultrasound would just provide more insights on the flow of blood in the artery (as well as describe ICA diameter changes which you can already measure on the CT).
Not saying you will experience any significant scary symptoms, but research shows that styloids that are less than 3mm from ICA increases stroke risk. So it’s just a precautionary thing to think about.
Man, I’m so grateful for all the help you’ve given me and keep giving me. I’m going to get more checkups to see if I can push for surgery — it’s not easy where I live because of their lack of knowledge.
@Deggui - It’s very common for ES symptoms to come & go but once they start, they can become worse & more persistent over time & new symptoms can join the old ones. It’s kind of odd that this happens. Sometimes you’ll be able to tell what you did that made your symptoms worse. For me it was hard aerobic exercises that involved my neck like “rope slamming” at the gym as that uses a lot of upper body muscle work. There can be other things that are less physical that can cause symptoms to flare like simply turning your head in one direction or another.
Fair enough if the tooth has been causing infections, it might settle some of the inflammation, could be worth explaining to the dentist about your styloid process being very close to your ICA so they know to go carefully…
Unfortunately the only way to know for sure if ES is causing your symptoms is to have the surgery, but when you put together the symptoms & look at the scans, it gives you more of an idea about whether surgery is necessary or not…personally having the styloids compressing blood vessels made the decision to have surgery very easy for me, I wanted mine gone!
I will also add this - I have been helping people with their imaging on here for the better part of the past year. I often see styloids in contact or compressing IJVs and sometimes ECAs. You are the very first person I’ve seen with true stylo-carotid syndrome where the styloid is directly compressing the ICA. And I’ve seen a lot of styloids and ICAs in the past year. I have not seen a single other member where their styloid was touching their ICA. I’ve seen them in close proximity but never touching.
what are the symptoms of the styloid touching the ICA? what kind of doctor can be aware of this?
The CT scan was ordered by an ENT specialist; nothing was mentioned in the report, and the ENT didn’t mention anything either.
Could the position in which the CT scan was taken affect how the structures appear?
eco doppler,angio-ct could be better to ruled out compression?
I don’t want to panic over this clinical finding. right now my main problem is getting asleep, im taking benzos that are helping me on that, but is difficult for to relax on my own.
@Deggui - C1 looks slightly shifted to the left (see the 1st 3D image @TML posted which shows your collateral veins).
Symptoms of stylocarotid syndrome are typically pain along the distribution of the artery, often giving headache, eye pain, temporary partial or full vision loss in one eye, Horner’s Syndrome, vertigo, and can be made worse by rotating the neck, or looking up or down. Additional symptoms can be transient ischemic attacks (TIAs = mini strokes) which affect either the right or left half of the face/body, or a debilitating stroke (which is rare but has happened in some cases).
Symptoms of stylojugular syndrome are typically migraine headaches, which can worsen when lying down w/o head elevation, visual changes such as visual snow/visual distortion, pulsatile tinnitus/tinnitus, feeling drunk, derealization i.e. distorted perception of reality such as the ground seeming further away or closer than it is, feeling like you’re on a rocking boat, vertigo, & pressure/pulsing in the neck. It can be made worse by rotating the neck, or looking up or down. Intracranial hypertension (IH) is the result of IJV compression, & that can cause CSF (cerebrospinal fluid) leaks, & if left undiagnosed for long enough, the IH can potentially cause Superior Canal Dehiscence Syndrome which is thinning of bones in the inner ear due to the high pressure inside the skull.
I had measured the distance from the odontoid process to the pillars, and it seemed to be similar with very little difference,but i only didi it on the axial view. The CT scan wasn’t taken with me in a fixed position, just lying down normally. Algo the ct scan was for soft tissue so not much high res there on images.
It happened to me not long ago that I felt like one side of my body was different or disconnected. At the same time i was having torticolis on the right side with levator scalp and upper trpezius pain. This feeling of dissociation lasted for several weeks, and I noticed it more when I smoked marijuana. Then that sensation gradually went away. It had never happened to me before.Now I’m taking anti-anxiety medication, and it doesn’t happen anymore, so I’m not sure if it was due to anxiety or something else, also tinnitus was reduced when taking the meds, i was super anxious but that time so probably my blood flow was also elevated.
Im panicking with this information. Im not having too much symptoms right now besides tinnitus.
Now i get something, no doctor did look mi ct in the right way, they only see on the axis slice , i didnt know it can be seen on all sides. This changes things a lot….
I´ll habe an appointment with a neck and head surgeon with this information.
ANother question, if i go through surgery i ll need my C1 shaved?
Nobody has a straight C1 that I have seen. My C1/C2 are way more crooked than yours. I specifically asked a neuroradiologist to comment on my crookedness of C1/C2 and they said it’s within normal limits. Here is my C2 which looks way off:
Here is just a small compilation of forum member’s C1s. Not a single one is perfectly aligned with the front or back of the skull, indicating a slight off-centering of the vertebrae. Really hard to judge CCI by subtle shifts in vertebrae, because it’s very normal (I would say it’s actually abnormal to have perfectly aligned vertebrae). You’d need a DMX or upright MRI to truely test for CCI.
Our body’s are full of muscle imbalances, starting from the feet up. A leg length difference of a cm is enough to cause imbalances higher in the spine. Think of it as very minor scoliosis patterns.
Yes, everything on the right side. I felt like my shoulder was falling forward, then I started having spasms in my lower eyelid, pressure in my ear and pulsatile tinnitus, inflammation around the retromolar space, and a strange sensation in my throat on the same side. I also had pain in the levator scapulae and upper trapezius when lifting my arm or in the mornings, mild tingling in my thumb, lower back pain, and a weird feeling in my leg. When I tried to sleep, I would sometimes wake up with panic-like episodes and shortness of breath, mild but deep pain below the mastoid process, and some pain at the base of my skull, a sensation of grit in my eye, and pain when pressing on the brachial plexus. All of this was on the RIGHT side and lasted for several months.
Currently, I have mild generalized tinnitus, insomnia (except when I take lorazepam and risperidone before bed), right-sided lower back pain (my leg on that side is 1 cm shorter), tingling around both shoulder blades, and hair loss. All of this has developed over the course of a year and a half. what i never have is dizziness or lightheaded.
Probably everything was exacerbated by being extremely anxious because I felt my body was off.
