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

[mist]

@Isaiah_40_31 @Jules

I thought it would be fair to give some feedback from me after some time.

Unfortunately not much progress since the writing, I’ve tried to reach out to radiologists to get the description of the IJV’s and styloids but I couldn’t find one with enough expertise. One of them even told me it’s no possible to have IJV compression by styloid or transverse process (sure…). I found about polish site describing Eagle’s https://www.zespoleaglea.pl/, the maintainer shared with me list of doctors who diagnosed/treated the cases.
I already have a scheduled appointment with a doc (in my city), who had patients with Eagle and also did surgeries (hopefully I can get some input from him), also I booked an appointment with neurosurgeon from another city who successfully diagnosed and treated patients with C1 instability (I got that contact from one physiotherapist who’s knowledgeable in the topic).
Currently my symptoms have worsened I feel so hard to keep my head up, literally feels like my C1 is so loose, also the pain is worse and it’s the same kind of pain as before (left side, feeling like something is literally drilling underneath my jaw).
In the meantime I tried looking more on the scans and I did some 3d reconstruction of them. It looks like my styloids are not long (same what you said Isaiah) but the left one looks really nasty comparing to the right one. I was wondering if it’s possible for styloids to injure the C1 ligaments? Asking because I have zero knowledge about the ligaments structure. Nevertheless, on the scans you can see everything is really close (the styloid is kind of kinking the IJV and on the other side we can see the transverse process literally laying on the IJV - at least that’s my observation).
In summary, I still think I’m not really the “typical Eagle case”, but looks like my styloid plays part in the symptoms due to the neck instability.

P.S to anyone with reading scans knowledge, I can share the scans files with you if you want to look at it yourself.

[Jules]

I’m so sorry that you’re feeling worse now, but good that you have a couple of doctors who may be able to help you…please let us now how you get on with them!

[Isaiah_40_31]

@mist - Thank you for the update. You’ve done a great job researching & finding the Polish ES site & getting a list of ES knowledgeable doctors. It’s also good news that there’s one in your city. I’m glad you’re also consulting the neurosurgeon for a second opinion.

Good job with the 3D images! Thank you for posting them. Both styloids look very thick & as you (& I) noted, the left one is a bit longer than the right & is very pointed & dagger-like. It looks like your left IJV is dominant as your right one is pretty small (many people have a dominant IJV). The left IJV does appear to be compressed by both the styloid & C-1 but it’s hard for me to tell which one is more at fault. I would say that getting your left styloid removed as close to your skull base as possible would definitely give that IJV more space & it might decompress on its own.

I have not heard of the styloids damaging ligaments of the upper cervical vertebrae but anything is possible. If the styloid’s angle of growth allowed it to come into contact w/ the ligaments of C1-C2, it makes sense there could be damage done. I didn’t reread our previous conversation to see if either of us suggested that you try using a soft neck collar to help support your neck. Some people have found it helpful both during the day & during sleep. Here is an Amazon link so you can see what I’m talking about:

https://www.amazon.com/s?k=soft+neck+collar+for+neck+pain&crid=2VTO1EGIUOBLH&sprefix=soft+neck+collar%2Caps%2C210&ref=nb_sb_ss_ts-doa-p_2_16

[mist]

Thank you Isaiah, always helpful.

I’m not sure, maybe I’m not that good at reading the images but I would actually say the left one seem more compressed, it literally disappears from the scan right after after C1 level, but I might be wrong
When it comes to the ligament damage, I was just wondering because my left side literally feels like it have no support (and all the pain comes from the left side), I have to literally use lots of muscle power to keep the head up and it could mean the ligament instability, also the distance between atlas and the styloid is so little, so there’s a chance that in a specific neck position they could collide but that’s just my guessing.
It’s also quite funny because I’ve been wearing soft collar for few days now, when I have the worst symptoms it’s pretty useful so it kind of forces me to have straight neck and I don’t turn my head so much.

Anyways, I wanted to ask you if by any chance you know if that make any sense to do MRI of soft tissue? I think that could show changes in the ligaments (if there are any), better than regular cervical MRI. I will be asking that my doc.

[Isaiah_40_31]

@Isaiah_40_31

The left IJV does appear to be compressed by both the styloid & C-1 but it’s hard for me to tell which one is more at fault.

@mist - I wasn’t very clear in the above comment. When I said “it’s hard for me to tell which one is more at fault.” I meant the styloid or C-1. I wasn’t referring to which IJV was more at fault. Left is clearly the problem.

[mist]

Hey guys again.

Another update of mine.
I had a consultation with a surgeon who’s specialized in ES. He confirmed that my IJV’s are flattened but he’s not really sure if Eagle has anything to do with it, he said that there’s more chance that it’s caused by the CCI. I fully agree with this statement and I will have a neurosurgeon consultation tomorrow (finally).
Before that I’ve redo the MRI (with contrast this time) and also on more precise machine with additional sequences on C0-C1. (i don’t have the radiologist opinion yet though)
I’m pretty sure tomorrow the CCI neurosurgeon will be reviewing that and we’ll see what he says.
In the meantime I uploaded the study here:
MRI CVJ

So if anyone here had an experience in reading the images in terms of CCI/ligament injuries, I would love to hear your oppinion.

@Jules @Isaiah_40_31
Thanks again.

[Jules]

I can’t give you an opinion on your images, but I hope that your appt goes well and you get some good info & answers. Let us know how you get on, thinking of you

[Isaiah_40_31]

@mist - How did your consult go today? Was your diagnostic MRI done w/ you in an upright position (vs lying down)?

I’m sorry I’ve been off the forum for a couple of days so didn’t see your message till tonight. I couldn’t open the link you posted, but am in @Jules situation. I can ID certain things on CT scans & MRIs if they’re 3D images but don’t know enough to comment on slices. I also don’t know what CCI/AAI look like in a scan. That’s something I should certainly learn since we have an increasing number of members with those conditions.

[mist]

Hey Isaiah,

It went pretty well. The neurosurgeon I visited was second doctor who noticed there seem to be a conflict of C1 transverse process and the IJV and that sometimes they simply shave that part to make the IJV run properly. He said that I should try a stiff neck collar for a month to see if that makes anything better or worse. After that he suggested that I can get a PRP or prolo by him (but only on the ligaments that are accessible thru back of the neck). I think it might be worth it even if it’s not on the ligaments that turned out to be the most injured (correct me if im wrong). He said that in some cases he’s also prescribing a HGH therapy to promote healing. He’s also aware that there might be needed to do the MRI in the upright position (till now I’ve only done the traditional ones) and a set of dynamic x-ray.
I will also send a form to the https://oreme.eu/ clinic, to see if I’m a candidate for a PRP ligament therapy (I think this is the only place in Europe that performs this kind of PRP injections thru throat).

So in summary I got a confirmation on most of the doubts I had and seem like there are not many options out there, but still there are few that I can try

PS. here’s a proper link to MRI https://www.dicomlibrary.com?study=1.3.6.1.4.1.44316.6.102.1.20240228143745636.91979724301918311312

[Isaiah_40_31]

Thank you for the update. I will take a look at your MRI tomorrow as it’s late for me tonight. I’m not great at knowing the details of what I see & I don’t know what CCI looks like but I can ID the styloids, s-h ligaments, hyoid, IJV, ICA & C1 vertebra so that’s a start!
It sounds like you got some good information from the appointment. I hope the suggestions the doctor made are helpful to ease your symptoms and that the clinic that does the PRP will accept you. I’ve heard good things about PRP therapy but less good about prolo.

[Isaiah_40_31]

@mist,

I humbly apologize that I said I’d look at your scan images today. I realized after clicking the link that it’s going to take me awhile to try to view them as I’m still learning how to use dicom library links. We have some other members who might be able to provide you with information more quickly - @LimeZest or @vdm if they feel ok & have time. If they can’t do it, I’ll suggest some other possibilities.

[vdm]

Spasmed neck flexor muscles, cervical kyphosis, multiple bulging discs, multiple desiccated discs, narrowed spinal canal, minimal spinal cord impingement.

I’m not a medical professional, so this isn’t a diagnosis but mere observations.

Structures related to the Eagle’s syndrome aren’t well visible, in my personal opinion, on this MRI.

Upd: just saw on your profile you are a programmer.
From what I know, working long hours on the computer, f***s up the cervical spine very easily due to the multiple ways the muscular structures are affected.

[mist]

Yeah all these things you listed already were told by my doc, so it’s a good diagnosis!
I’m really curious about the ligaments though, because it seems that it’s what’s causing pain, IJV compression and other symptoms. I will have more info from radiologists this month, so I will report.
Regarding my day-to-day posture, you’re 100% correct that my job was contributing a lot to my current state, I’m almost certain that it’s likely the cause of my todays problems, but I’m trying my best now to minimize any other damage and working on it with physiotherapist, also I no longer have typical neck muscle pains like I used to because I changed my environment/keeping my posture right.