I was able to upload my scan to DICOM library. Below are the 3 links. My scan had so many series so I just picked the 3 different views. Anyone with CT knowledge, please view the scans as they originally load, which shows the contrast, then click windowing, then CT bone, and then view the scan again.
What I am looking for in my scans is:
Is my stylohyoid ligament calcified?
Is my hyoid bone elongated at the tips, or are there any other problems with it?
Do you see any stenosis or hypoplasia of my major arteries and veins, either in my neck or head that might make me feel strangled when lying down? (I already know about the right vertebral hypoplasia and the narrowing of the left transverse sinus.)
Also, in the images below where I am pointing, I have clicking all day long and even when I barely put pressure there for the pics, it gave me an intense tickle in my throat that made me cough for a few minutes. Is there something strange happening at that level in my CT?
One last thing… I need help with a couple things: I upload the 3D models the radiologist made of my arteries to DICOM library but when I opened the DICOM library links for them it was blank, even though a thumbnail of my artery model was off to the left. Any tips for that?
And, is it possible for me to make a 3D model of the styloids with the arteries and if so, how? I only have one without arteries from a CBCT.
I fully understand that any feedback I get from members here is not medical, just your own personal opinion, but I’d still like to have things to bring to the doctor to ask him to look into whenever I have my appointment. Thank you!
If you want to take a look at these scans in 3D the best program is Slicer. Take the series with the most slices, in your case Series 4, and follow the directions in this post to reconstruct them into a 3D model for viewing manipulation. Making Your Own 3D Images from CT Scan- 3D Slicer Tutorial
You can then make similar 3D models like the radiologist did. The reason the 3D models the radiologist made don’t work in DicomLibrary is because they are just 2D pictures taken from a 3D reconstruction. You may have multiples images that allow you to simulate spinning around the model, but your really just flipping between 2D images. All the images below were made in Slicer with your Series 4 dicom stack.
Is my stylohyoid ligament calcified? There is some minor calcification. The worst side of the calcification is on the right and it does have some compression of the dominant right jugular vein. I circled in red the compression from the right styloid and right C1 transverse process.
Is my hyoid bone elongated at the tips, or are there any other problems with it? The hyoid bone on the right is somehow stuck between the carotid artery where it splits. Pretty sure this is not normal. I don’t know how this affects you, as you turn your head, eat or talk. The connected ligaments/muscles must somehow overlap the external caritod artery at the very least. It does look like the ECA has adapted over the years to account for this.
Do you see any stenosis or hypoplasia of my major arteries and veins, either in my neck or head that might make me feel strangled when lying down? (I already know about the right vertebral hypoplasia and the narrowing of the left transverse sinus.) Given that the left transverse sinus is narrowed significantly, the right transverse sinus I would expect it to be much larger given it’s doing most of the work.
Also there is a calcification where the right jugular vein meets the subclavian vein. I have this calcification on my right side too, but yours is larger and on your dominant jugular vein. This is something new that I have come across and have no idea if it is significant or not. This is obviously a question for a neurosurgeon or similar specialist.
Hi @BlacknBlueSaint I won’t comment on narrowing on transverse sinuses and vertebral artery as you already know them. Also, as @GCD indicated you already have IJV compression by the Styloid and C1 so I won’t expand on that as it is covered by @GCD. I think you are suffering from what is known as Carotid Artery Entrapment by the Hyoid Bone. This is when the Hyoid bone is located between the bifurcation (branching into ICA & ECA) of the Carotid Arteries. Your right hyoid bone appears to be rubbing your Carotid artery separation and potentially could be causing your blackout (syncope) symptoms when you lie down. You will need to have this addressed as soon as possible as it is linked to strokes. The hyoid moves each time you swallow so if it keeps hitting the Carotid bifurcation, it will eventually damage it causing dissection or occlusion. I also believe the right hyoid tip is also irritating the nerve fibers on the carotid sinus/body as well as branches of Vagus nerve and glossopharyngeal nerve causing your swallowing issues, Lump in throat feeling (globus sensation), strangulation sensation…etc
Here is where the damage could be happening. You can see the slight dent on the ECA (Red arrow). This could be the result of a repeated hitting/rubbing of the Hyoid bone.
Here are axial and Coronal CT slices showing Hyoid bone in the Caortid bifurcation. Carotid bifurcation (Red arrow), ICA (Yellow arrow), ECA (Green arrow) and Hyoid tip (Cyan arrow). You need to address this as it is more critical than the IIH issue.
Here is the internet images to show you the nerves around this area. I am pretty sure the hyoid bone is irritating them.
One of my Canadian colleague (@CJsBattle) is now expert on this as he suffers from it as well and is awaiting for surgery to trim the hyoid bone. You might want to discuss this with him as he has read a lot of literature on it and is up-to-date on this particular issue.
Also, I have commented on similar cases before. You can find them links below, if you need more info.
Here are the symptoms of Carotid and other nerves involved in your case
@GCD I thought you got this one covered . I am glad someone is also helping with images now. Yeah, I agree, the IIH thing is minor compared to what can happen if blood is cut off from the brain. You do not want to wait for that. I think the stenosis of transverse sinuses and IJV could be addressed next.
Thank you so much for all your input and taking the time to put all that together for me! I will definitely ask the doctor about all the things you pointed out! I greatly appreciate you doing this to help me!
I think she will also need to have someone look at right VA (not sure if it can be stented). The signal attenuates so much just before the right VA & the left VA join to make the basilar artery. This could be potentially contributing to her Vertigo but I am not doctor so I am not sure.
Right VA (Cyan arrow) is almost near dim compared to the dominant left VA (Red arrow). Potential etiology for vertigo.
Thank you so much for putting all of that together and attaching so much valuable information. It’s crazy because Connor has been helping me with this all morning, so it is incredible to have such fantastic support from you guys and everyone here! I really appreciate your time and everything you shared. I’m about to go read it all.
I put in an urgent message with my doctor’s office regarding the hyoid bone syndrome, so I’m praying they get me in ASAP!
The only thing I can add, & it has been mentioned indirectly, is that when you poke your neck as in the pics above & it makes you cough, you’re most likely stimulating or irritating your vagus nerve. It’s the main source of a cough.
That is a picture of your dominant transverse sinus on the right side. Your left side is very narrow (non dominant) and that is usually ok as long as the dominant side has good flow. The transverse sinuses are the major blood outlflows for the brain. So a narrowing on both can lead to all sorts of neurological problems.
I still think your hyoid bone location is the most probable cause for your systems, but the only way to try and pin point the site of stenosis is to have an interventional neuroradiologist do a venogram/angiogram with manometry. The doctor will insert a catheter into your blood vessels in your neck and head. They will release dye and track the flow. You will repeat the test with different head positions to check for sites of impingement.
I had this preformed with Dr. Athos Patsalides and you can look at my scans to get an idea of what I mean. He also did pressure tests to see if the pressure in my head was abnormal.
Wow, very interesting! So I’ve been trying to get in with Dr. Lawton at Barrow Neurological Institute and he had an endovascular surgeon call me because they want to do that exact test before they see me. The issue is they’re in AZ and I’m in ID. I will absolutely travel for a good surgeon, but I’d at least like to give the vascular surgeon in my area a chance because if he is really good, I may be able to do everything I need here. So that appointment w/the vascular here is on the 31st and I’ll go from there.
Also, the ENT I saw up here about a week ago is consulting a vascular surgeon to see what the best dynamic test to order for me is, so I’m waiting on that, too, in case they can get the same test ordered sooner.
What is the thing you circled in my picture? And, what was it like to get that test done? Were you awake? Scary? Feel any of it? Any side effects from it? And what was the pressure test like? Thank you for sharing your scan. I’m going to check it out now!
It looks like just these documents at the very end didn’t get anonymized because they look to be images of a document, rather than a document itself, so maybe it didn’t pick up that there was a name there, but everything else and the whole scan seems to be anonymous.
The test is considered a minor surgery in itself. For me Dr. Patsalides placed a catheter in my femoral vein and snaked it up into my jugular vein just above C1. Released dye and tracked it with multiple X-rays. Then repeat the process in different head positions. The next step is the catheter goes further into your brain and repeat the process to test venous drainage in the brain.
Then I had a balloon inserted through the catheter above C1 again, inflated and pressures measured in my head to see if I had enough collateral veins to compensate. I did not compensate well and that really hurt especially in my ear.
The last part of my test, which is more crucial to you, was testing my arterial flow. Catheter went into my radial artery in my right arm and dye was injected into each carotid artery separately and traced in various head positions.
It requires that you be under partial anesthesia, but not completely out as they need you to respond to their commands and tell them how you feel in the various positions. The catheters don’t hurt, but I had massive bruising for 1 month all around my groin from the femoral vein catheter.
I was warned that the dye they inject causes you to see weird patterns and can happen for up to a few weeks after the procedure. That night I had the worst headache and had kaleidoscope zig zags in my peripheral vision. It happened a few more times after the testing, but never as intense as the first time.