Venogram results interpretation

General
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I recently had a catheter venogram and angioram done, and I’m hoping some of you can help translate the results while I wait to see Dr. Hepworth in a few weeks. For context, I was diagnosed with bilateral Eagles Syndrome with compression of my Internal Jugular Vein on both sides, and had my left styloid removed in December, 2022. While at first I had great relief, all symptoms returned within a few weeks, hence getting a catheter venogram done.

The venogram report repeatedly states “external compression of the posterior right internal jugular vein is seen” in reference to the “head and neck region.” Can anyone tell me if the location referenced is at my right styloid? Or is is somewhere else in my right jugular vein?

Under the section where the catheter is in the “vertebral artery” the notes say “There is in the late venous phase some reversal of flow filling of the posterior fossa. This may be related to some element of venous hypertension.” Also stated: “In the venous phase there may be reversal of flow of cortical veins in the venous phase in the posterior fossa.” How exactly does your blood manage to flow backwards, and where in my body is this talking about? Is this finding consistent with IJV compression at your styloid?

Then, there’s this great paragraph:
“AP LEFT COMMON CAROTID ARTERIOGRAM: With the catheter in the left
common carotid artery and imaging the head and neck area, contrast is
injected, an angiogram is performed and the study is reviewed. Normal
arterial phase is seen. An anterior communicating artery is present.
The left posterior communicating artery is absent.”
Does that mean that I’m missing an artery?

Also recorded:
" AP MAGNIFICATION LEFT INTERNAL CAROTID ARTERIOGRAM: With the catheter
in the left internal carotid artery and imaging the brain and skull
base area, contrast is injected, an angiogram is performed and the
study is reviewed. Normal arterial phase is identified in the brain.
The anterior communicating artery is intact. No evidence of a left
posterior communicating artery. In the venous phase intracranial
venous structures are noted. Again in the cortical veins there is some
evidence posteriorly of some element of reversal of flow in the veins
themselves. This could be consistent with some element of restrictive
outflow of the venous sinus system."

Just trying to understand how all these notes relate, and translate the medical language into plain English. Any help is appreciated!

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That’s likely an anatomical variant of Circle of Willis which is a circle of arteries in your head to ensure redundancy in case some artery is affected. Very few people have “normal” (full) CoW. Most people have one or another variation.

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Dr Hepworth will understand and explain. He had me consult for cerebral angiogram, venogram, etc., too. To me it sounds like your abnormalities are likely still impeded jugular related, although certainly I don’t understand all of this. Reversal of flow I read about in research on CCSVI, which was a hot topic 10 years ago. Of course Dr Hepworth will understand and explain.

So sorry your symptoms recurred. Improvement on the way…

Violin

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Well this clearly states that “This could be consistent with some element of restrictive
outflow of the venous sinus system.” Which can only mean that you either have outflow restriction/narrowing on primarily Transverse/Sigmoid Sinus or down below on Internal Jugular Veins. We can’t tell but since he said venous sinus system I can only assume Transverse/Sigmoid sinuses.

Posterior fossa is the skull base so we can only assume that blood outflow is restricted either at the Transverse/Sigmoid Sinus or the Internal Jugular Veins. There are only 2 ways for the blood to flow when outflow is restricted - blood flows alternate route AKA Collateral veins or it gets pushed back to the brain - reverse flow - which could be what is causing the IIH symptoms or CSF leaks since higher fluid is putting pressure on dura which can give in under heavy pressure.

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