Possible IJV compression?

[mist]

Hello community!

First of all, I’m really pleased to write there!

For the past year I’ve been struggling with following symptoms: dizziness, nausea, unstable walking, severe insomnia, tinnitus, pressure in the head, neck pain and many more.
I’ve been to different doctors during this time. It all started with typical tests such as head MRI/CT which obviously showed no defects. I also been to psychiatrists to rule out any psychosomatic causes, since then I tried few different meds but none of them really helped with my symptoms and the doctors didn’t give me any obvious diagnosis. I had neck MRI as well, since I had pain in that area for quite a while, the test showed some degenerative changes such as kyphosis, disc bulges, degenerative changes at the edges of vertebral bodies but most importantly I would say in the case of IJV, my c1-c2 has some sort of instability and there’s also a swelling and asymmetry (it was detected after second MRI that my physiotherapist told me to do, because he was worried about one thing during manual tests of the neck). The case with the instability led me to thinking that it could cause some sort of vascular problems, e.g. compression of the veins in the neck. I found some articles on that in the internet and the symptoms described were matching mine, so I talked to my doctor which told me to do the CT Angiography of the neck and brain vessels. After some time I had a description of the images but they didn’t describe any defects regarding the arteries, but… there was no description of jugular veins which I think are not usually checked when doing arteries scans (correct me if I’m wrong, but I would not be surprised since the first MRI of the neck also missed the C1-C2 description)

Here are some of the images of CT angiography:
I did place some arrows on the images which I suspect the compression though I’m just a newbie learning the anatomy, not a doctor so don’t read this as my own “diagnosis”.

To me the IJV’s looked a bit flattened, especially the left one but I might be totally wrong.
Axial:

Sagital:

Coronal:

Some recordings for a deeper look as well:

I asked radiologist today if he could check the images in terms of IJV. I will have response at Monday.
I thought it’s worth a try posting there, since I saw there were already plenty of people who had similar tests done.

All help appreciated, thanks!

EDIT:

I also include the “motion” x-ray:

Unfortunately the images don’t show rotation/flexion to the sides, so they are probably not that helpful.

[Leah]

Welcome to the forum. You’ll find enormous help and pointers here. Surely looks like compression to me by cervical spine (I’m not sure at what level). It is most often seen at C1 due to the width of that vertebrae.

That being said, my C1 is pressing on my left IJV but that IJV is congenitally small, and my right one is wide open. So the feedback I’ve been given by multiple doctors is that I do not have vascular compression.

You can look through the posts and will see many images that look like yours. Have a look at @GCD s posts. He had surgery in May for this.

I’m so sorry…. this is a long process to go through but you are ahead of the game with imaging already done . I have found no one is in a hurry but me. This is test of patience and endurance for sure.

[Isaiah_40_31]

Hi mist!

Welcome to our forum! Your symptoms do match up w/ those caused by IJV compression. After looking through your images, here are my conclusions:

It looks like your right styloid is in two pieces (see 2nd video at 12 seconds) so part may be styloid process & the section below the styloid would be calcified stylohyoid ligament. The fact it’s in sections could be contributing to your symptoms, too. The left side (same video at 5 seconds) doesn’t look long, but it does look thick. Styloids don’t have to be longer than normal to cause problems. Other features such as thickness, angle of curve, how twisted or pointed it is can contribute to the styloids causing trouble. We do know that CCI/AAI (craniocervical/atlanto axial instability) can cause the IJVs to be compressed by the transverse processes of C-1 or C-2 since these vertebra more mobile than they’re meant to be. This looks to be part of your situation. Besides the possible styloid compression, it does look like you have bilateral compression from C-1 w/ the left side being the worst. Please bear in mind I’m not a doctor & am not terribly adept at reading scans so hopefully those members with more skill than I have will also give their opinions.

Neck pain could be coming from CCI, but your styloids could also be causing some of the pain. It didn’t look like any of the scans you had done were dynamic i.e. w/ your head in varying positions. This can be critical to finding vascular compression because it doesn’t always show up when the head is in neutral.

We have a couple of members who’ve had C0-C2 fusion for CCI & have said it really helped w/ the CCI symptoms. Are their any doctors in your country who do that operation?

I’m glad you’re having your scans re-looked at to assess your jugular veins. Please let us know what you hear.

In your stationary coronal view, the compression to your IJVs appears to be bilateral with compression being worse on the left side

[mist]

Thank you such wonderful people. Regarding the imaging. I also have some X ray scans in various head positions which I can post tomorrow if that would help but generally I know it’s pretty hard to get motion tests in my country so not yet sure what techniques are possible. I can also post the MRI scans of the neck. Anyway, I feel like I’m really close to getting some sort of diagnosis, and as you both said the chance that I have this issue is probable. I feel really hopeful but I know there’s a long way for getting better. Thanks again and hopefully I can get some decent feedback from doctor soon.

[Isaiah_40_31]

Seeing your X rays may be helpful in getting a better look at your styloids & your hyoid bone depending on what area was scanned. MRI could also be helpful.

[Jules]

I agree with @Isaiah_40_31 that there’s C1 process compression, but it does look like the styloids are playing a part in that too…some members on here with jugular compression have been prescribed Plavix or other anti-coagulants which has helped, it might be worth asking about trying?

[mist]

Hi Jules!
Once I see the doctor and have description from the radiologist, I will for sure ask if it makes sense to use that in my case! I looked at the similar posts there and saw some other people were having success in checking their scans, @KoolDude @Buzz @GCD hopefully guys you don’t mind tagging you there