Opinions on my scans and images please

[KoolDude]

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 are the 3D rendering of right Hyoid bone tip in the Carotid bifurcation. Carotid bifurcation (Red arrow), ICA (Yellow arrow), ECA (Green arrow) and Hyoid tip (Cyan arrow).

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.

@KoolDude

Hi Saxine,

Given the images here, I am not a radiologist nor a doctor and my suspicion needs to be verified by a trained radiologist but I have suspicion that you might be suffering from a rare right side carotid artery entrapment by Hyoid Bone when you turn your head as it is very close to the right carotid artery as shown below. I circled the carotid artery bifurcation (where it branches) and green arrow points the Hyoid bone almost touch the artery branches. This could explain your intermittent stroke like episode on the right side facial droopiness and weakness after you turn your head but needs to be confirmed. I have found few cases in the literature here (Frontiers | Hyoid Elongation May Be a Rare Cause of Recurrent Ischemic Stroke in Youth-A Case Report and Literature Review | Neurology ) ( Carotid Artery Entrapment by the Hyoid Bone-A Rare Cause of Recurrent Strokes in a Young Patient ).

@KoolDude

Yet another interesting study with carotid entrapment by the Hyoid bone. Might contain some surgery pictures so little warning here. The following images are from the study and see how similar your images on the Hyoid bone look to this one. There is also video animation in the study link which you can download and watch how the right horn of the hyoid bone is in between the two branches of the carotid (ICA & ECA)

Fig 1Computed tomography angiography of the neck. A , Multiplanar reconstruction (MPR) demonstrates the interposition of the right cornu of the hyoid bone between the right carotid arteries. The arrow indicates the right internal carotid artery. B , Anteroposterior and (C) lateral views of a three-dimensional reconstruction show the carotid artery and the cartilaginous and bony structures of the larynx and an osseous background. Note the low carotid bifurcation on the right side at C 4/5. C , The arrow points at the interposition of the right cornu of the hyoid bone between the right carotid artery.

Study Link : Carotid artery entrapment by the hyoid bone

PDF Format : Carotid artery entrapment by the hyoid bone.pdf (1.3 MB)

@KoolDude

@CJsBattle Not a radiologist here but it seems to me that your left Hyoid bone might be touching/compressing/irritating one of your Carotid arteries as it lies in the Carotid bifurcation (where the Carotid artery separate into Internal Carotid & External Carotid). It is not very clear as the rendering you chose might be obscuring the clarity of the image. There were a number of cases similar to yours and I have written more details on those posting regarding this type of issues. One of them is here (Could this be vascular compression? - #7 by KoolDude ). This is condition (Carotid artery entrapment by the hyoid bone) is linked to stroke as well so the earlier you attend to it the better. Do you feel pre-syncope (lightheadedness/blackout), Stroke like episodes when you turn your head? It would also be better if you can also post the frontal image so we can see the Hyoid bone clearly.

Cyan arrow points to where I believe the Hyoid Bone is touching one of your Carotid arteries.

Here are the symptoms of Carotid and other nerves involved in your case

Source : https://emergeortho.com/wp-content/uploads/2018/04/1-s2.0-S2468781220301399-main-2.pdf