I do not mind getting a good physio but since my jugular vein is compressed and I do not know if there is a good physio-therapist that won’t make things worse by messing with my neck muscles & bones.
For example, when I was doing the dynamic catheter angiogram/venogram, they found when I turn my head to right, they do not see a collateral filling via condylar vein which was translated as a temporary relief of styloid & C1 compression but on head turned to the left and on a neutral position, the compression does not get relieved hence the prominent appearance of collateral venous filling. So provocative movements, while they could potentially relieve my symptoms, they also have the potential to make things worse. so I am undecided on this at this point. May be after surgery to make my neck bit more flexible.
BTW, I put some of the images of head movement during the Catheter Angiogram along with the report below.
Head tilted to left - Collateral filling can be seen.
Head tilted to right - No Collateral filling can be seen.
Head in a neutral position - Collateral filling can be seen.
Report finding:
Diagnostic catheter was advanced over the wire under roadmap navigation to selectively catheterize the right common
carotid artery, left vertebral artery left common carotid artery. Venous phase angiograms were obtained from each
selective catheterization including visualization of brachiocephalic/jugular system in the chest, neck as well as intracranial
dural venous sinuses. Venous manometry was performed with the catheter in left common carotid artery. Additionally,
provocative testing was performed with head turned to the right and to the left respectively and the venous outflow was
assessed.
The following observations are made:
- On the right common carotid artery injection and left vertebral injection, the left transverse sinus is the dominant sinus
but there is also nondominant flow into the right transverse sinus. Right transverse sinus is not hypoplastic but only
nondominant. Bilateral prominent condylar veins are seen, left more than the right. - The left common carotid artery angiogram shows that the left hemisphere is draining almost exclusively through the left
transverse sinus. - There is compression of internal jugular vein at the level of C1 transverse process-styloid process bilaterally.
- On provocative testing with head turned to the right and left respectively, an interesting observation is made: When head
is turned to the right, the left condylar vein is no longer opacified. With the head in neutral position or turned to the left, the
left condylar vein is prominently seen. This suggests that with head turned to the right, there is improvement of the venous
outflow, by relief of the compression at the level of styloid process-C1 transverse process with a better downstream flow
towards the heart with consequent reduction of venous reflux into the left condylar vein. This may explain his left-sided
pulsatile tinnitus. - There is no evidence of dural arteriovenous fistula.
There were no complications during the procedure.
The catheters were removed. Hemostasis at right common femoral vein access was achieved with manual compression.
Left common femoral artery was closed using Angio-Seal device after confirmation with a groin angiogram.
Patient was transferred to surgical daycare with stable vital signs and at neurological baseline.
IMPRESSION:
Eagle syndrome, with prominent venous reflux into left condylar vein - this is the most likely cause of his left-sided
pulsatile tinnitus. This venous reflux improves with head turned to the right. See detailed explanation above.
Dominant left transverse sinus.