We got CTV imaging done for daughter #2 today. We are posting them here hoping for some feed back from those of you with experience. Anything jump out at you on these images?
The styloids don’t look long at all, I’m sorry that I can’t label anything for you, but looking at the left side where you’d expect to see the styloid it looks pretty thick & unusual by the base of the skull, & then there’s a small piece of calcification below this, so could potentially be causing some compression right at the skull base?
It looks like there’s a very small amount of compression of the IJVs by the C1 process when you look from behind, although it’s not so obvious from the side views… But quite a tangle of blood vessels below the skull base so these could be collateral veins, & that could indicate IJV compression…You’ve had that confirmed anyway, so I’m surprised that it doesn’t look that significant on these images…
Your daughter’s neck looks very straight so it’s lost it’s lordotic curve, which can sometimes make ES symptoms worse; there are exercises which can sometimes restore the curve, but do I remember right that she has EDS or other issues? If so these might not be good… Her vertebrae look pretty off kilter from the rear view too?
Yes she does have EDS diagnosis but by a cardiologist, who also diagnosed her with hypovolemic POTS, so not sure what a specialist would say…. as far as symptoms she has severe daily headaches, noise intolerant, black outs when standing from sitting, daily fatigue, restless nights which can include times of falling asleep for a while then getting ‘black outs’ in which she cannot move or get her breath until the ‘spell’ passes. When standing while working that posture creates worsening headaches. Would the hypovolemic POTS play into what she is experiencing?
Yes we noticed her very straight neck also. And we asked her if she was laying straight when the image was taken and yes she said she was as straight as could be. She is seeing an upper cervical chiropracter at least 2-3 times a month and he had done rotational x-ray images of her neck and noticed extra rotation at the C4-C5 area, if I remember the right location. Thanks for saying something about her neck as we wondered what others would say.
1 Like
@BuckeyePrincess - I’ve annotated your daughter’s images below but am somewhat uncertain about what’s going on w/ her carotid arteries. I’ll comment below each picture.
In this image but I would have expected to be the ECA (external carotid) branches off the common carotid artery & goes across her face. That vessel appears to have a kink in it & then a makes another somewhat tight bend before heading across her teeth & up her nose. It’s possible that the ECA is the other, barely visible artery I marked but then I have no idea what the vessel across her face is. At any rate that might partially explain her blacking out episodes.
On the right side, what appears to be her ICA (internal carotid) looks to be compressed by another vessel which appears to be an offshoot of the IJV or one that is tucked partially behind it, but I’m not sure what it is. You can see that the ICA is a bit distended above & below the narrowed area I marked. If that is her ICA it’s extraordinarily narrow which could also be contributing to her periods of blacking out. What appears to be her ECA in this image is a repeat of the left side in that it runs up & across her face. I’m guessing it’s not the ECA but another vessel, but if that’s the case, I can’t find the ECA on the right side.
In this image the area of compression on the right IJV is visible but not as much on the left side. It’s curious to me that she has a higher density of collateral veins on the left than the right even though compression appears worse on the right. It could be because her cervical spine curves slightly to the left, that in head positions other than neutral, the IJV compression is worse on the left.
1 Like
It’s hard to say what’s causing what for your daughter, she has alot going on as @Isaiah_40_31 has pointed to on her imaging…and just to add to the mix the vagus nerve is alongside the IJV so if the IJV is compressed the vagus nerve could be too, & this can cause BP changes, heart arrythmias, breathing issues & possibly black outs perhaps (I don’t know if vasovagal syncope can be caused by irritation of the nerve?). 
1 Like