I am just grateful for the pic. I am in shutdown mode at the moment but I am going to use it to ask for my out of state referrals since the ENT couldn’t even recognize it was an issue despite the neuroradiologist pointing it out. I can mentally only handle so much of this battle at a time.
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You can see that the IJV is squashed between the styloid & transverse process of C1 as it’s size is quite minimal there. Any doctor who denies the IJV is compressed or believes it doesn’t matter needs to go back to medical school!
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It’s such a battle to get treatment, I hope that you can rest up, and get your strength back to keep going with the fight. Hugs to you 
A post was merged into an existing topic: Xray showing elongated styloid process?
I downloaded Radiant. Here is a 3d skull. The notations on my report are for the right side. I can’t post what I am thinking I am seeing because it surely isn’t right (and it kind of horrifies me) so I am going to see what you guys think. The top one is where you can see the hairpin curve of the carotid artery.
Yep, there it is. What is that vein or nerve or whatever between the styloid and the jaw on the right side.
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Nice job on the 3D imaging @JugularEagle! Both of your styloids look thick which can dispose them to cause symptoms even at shorter lengths though your right side does look significantly elongated. Your left side from a distance looks to be normal length, but in the close up image, it looks somewhat elongated, too.
The hairpin turn in your ICA is pretty crazy, & it’s position in the front of your neck makes it appear as though it could get crunched by looking down &/or to the right, though I can’t say that’s the case for sure, but you have had irritated/compressed ICA symptoms so that could explain why.
It looks like your right IJV may be your dominant jugular vein based on it’s size, but a compressed is usually enlarged, so your IJVs may be more evenly sized than they look right now. Your left IJV is pretty thick down closer to your collar bone which can indicate compression lower down such as is the case w/ Thoracic Outlet Syndrome. Do you have any TOS symptoms?
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Well, yes I surely do have symptoms of TOS now that I looked them up. However, I also have other things that could account for some things that fit into the rheumatology area of medicine. I will have to add this to the list of investigation.
I was told that because the dye was injected into the left side it would make things look different so that might account for some of what you are seeing.
I had asked for 3d rendering on my CTA and they did send it out for 3d but what I got back wasn’t this beautiful vision that you get with Radiant. I think to do estimated neck flexion that you see in studies you have to get SLICER and something else to project. I can barely handle Radiant which is user friendly.
take a look at this by the hairpin turn. radiologist referenced :
the styloid process closely approximates the cervical right ICA with a
thin interposed fat plane (coronal series 502 image 123). Torturous
right cervical ICA with focal, approximately 50 percent narrowing at
the level of C2-3 at a hairpin turn (coronal series 503 image 122)"
I dont know how accurate this is but Radiant is amazing
I can see that because of the tight turn in your right ICA, there is narrowing right at the curve, & that compresion could become more severe w/ various head positions thus cutting down the blood flow to your brain on the right side substantially which could causing stroke-like symptoms. I don’t know how that’s fixed during surgery but I’d think the artery could be straightened out w/o doing harm to it. I wonder if that branch of your carotid is extra long thus the curve to help take up the slack or if it just took an alternate route to your brain?
I’m sorry you have TOS symptoms. There are some very good TOS surgeons in this country so you probably can get a referral & diagnosis or not, if it’s something else…,
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That imaging is pretty amazing.
I was looking at your story and had to stop reading it because it surely raised my anxiety level sky high. It brings home that it takes a certain degree of luck to pick the right Doctor who does the right treatment. At my age I cant be messing around with surgery after surgery while they try to figure it out!
I really hope you get it sorted out!
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I agree with @Isaiah_40_31 , I would add that your styloids look particularly thick at the top, so could be compressing the IJV where it exits the skull base- the jugular foramen where it does exit is right next to the styloids. I agree too that both IJVs look like there could be compression below the collar bone area, so could be TOS. Your carotid artery is certainly unusual!
I’m not sure what blood vessel it is, but it’s not a nerve as they don’t show up on a CT…
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Two years ago I had a CT orbital scan. I put it in Radiant. It doesn’t go down far enough to measure but someone should have said something about what this shows. I decided to post in case anyone has an orbital so you can see that it can give you info if you do not have the full CT
I don’t know how big this space is suppose to be for the jugular but you can see there isn’t much space:
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Interesting images, thank you for sharing them, @JugularEagle. They do show the relationship between your styloid & C1 pretty well!
It’s so frustrating, we see it time & time again that it’s not picked up on scans, could’ve saved you so much pain & time! Elongated styloids or calcified ligaments don’t always cause symptoms for people, so I suspect that’s why it’s not commented on, but when someone is having a scan because they have neck pain etc you would think they would comment on anything abnormal! 
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