Wanting to Rule Out Vascular Involvement

My last CT Scan w/ contrast measured my styloids at 3.5 cm (left) and 4.0 (right). I have had the most pain on the left side, so I believe there may be an odd angle of my styloid. Lately my pain has been not as severe but I’ve had more issues w/ dizziness, feeling off-balance and out of it, and I sometimes have a headache that Advil will not touch. The headache is right behind my eyebrows. My last CT scan stated “There is no evidence of jugular vein or carotid artery compression at least with the patient’s head and neck in neutral non-rotated position. Neural impingement cannot be excluded. There is no mass or inflammatory process surrounding either elongated styloid process”. I still have concerns that my styloid is impinging my carotid artery or my jugular based on my symptoms. I would like to ask my ENT for a MRA to rule this out. Is this the right test to ask for? Some days my dizziness and other symptoms are barely there and other days they are there full force. I do not understand why there is such a difference from day to day. Sometimes I wonder if a certain sleep position puts pressure on the wrong place all night and then I suffer more the next day from pain or dizziness or both.

I don’t think that an MRA would show anything different to a CT with contrast, but obviously am not a medical professional, so that would need to be discussed with your doctor. I know that others on here have found that their styloids cause vascular problems in certain positions, so have tried to get a contrast CT with their head in those positions, but it can be difficult. The report you’ve mentioned states that there’s no evidence of compression in a neutral non-rotated position, so you could use that to explain your case, that you feel certain positions could be causing compression. A headache behind the eye is certainly one of the symptoms mentioned with carotid artery compression/ irritation, and dizziness can be down to either artery or vein compression. There’s more detailed info about symptoms in the ES Info section, in the Newbies category- you could try printing off some of the research articles mentioning these symptoms and talking about your concerns with your ENT.
I know personally that my dizziness and the feelings of pressure in my head were worse some times than others- I think that this was down to increased intracranial pressure from venous compression, and any even slightly strenuous exercise, or any stress would make symptoms worse, plus getting hot etc. I don’t know if you’ve noticed anything in particular making yours worse- you could try keeping a symptoms journal to try to work that out, and also perhaps try a different sleeping position, like more upright? I know that lots of people have found that their pain is worse some days more than others, and can’t work out any cause, so you might not be able to work out what’s causing it…

Yes, play around with head position. Use slow movements and then hold position, wait, and observe. Take notes. It’s surprising how many years I went without noticing my trigger positions. I think I subconsciously avoided them, or I moved too fast and overlooked the changes. Also how frightening it was to find them.

Hey Beach Girl, I am having a lot of those same symptoms. I’m having surgery August 29th. My Rhumatologist had me get a vascular scan that was an ultra sound in order to rule out vascular involvment. The test showed nothing being impinged - but the test itself made me very sick for about 5 days and basically I’ve never been the same. For me I believe it’s because the ultrasound wand had to push on the stabbing styloids. By the way our styloid measurments are similar only “mirrored”. My Rhumatologist and my sister who is a medical professional have both warned me that symptoms will seem strange just because of all the nerves that can be involved. The dizziness for me seems like a nerve that belongs to my middle ear. I’ve had some middle ear “history”. I guess I’ll find out Monday what’s happening on the right side anyway. The vascular test did find some good news. I have no cholesteral build up. I plan on eating straight butter so that other peoples vessels don’t get jealous :wink: Hang in there! Mark has a good suggestion :slight_smile:

I’ve had surgery for the vascular version of Eagle’s involving my jugular vein. I had many doctors look at my cat scans and say there were no issues. I finally saw a neurovascular surgeon that could see that it was compressed. After surgery he said that with my head in certain positions that it almost completely blocked off the vein. My situation was complicated by the fact that I have a strange anatomy and only have a jugular vein on that side. As far as symptoms, I would wake in the middle of the nite with horrific headaches that would get better as I got up. I would also wake up in the middle of the nite with both visual and audio hallucinations. (That was a fun one for my boyfriend) During the day, my equalibrium was off, I stumbled and had very poor coordination. Intercranial hypertension can cause many crazy symptoms. I hope you get some answers soon.

So I need to make an update on my vascular test comment. After all the tests etc once I had surgery it was found that my carotid artery was dueling with my right styloid bone. It was also discovered that the bone suddenly changed direction - probably from a car seat belt incident. So for me the ultrasound vessel test was a complete waste of time and only made things worse. BTW I’m no longer dizzy and able to ride a bike :sunglasses: Hang in there! It will get better!


hey Susan, I reckon I have right side jugular compression, after putting my CT angio picks in radiant viewer to get 3D I can see it is twice as large as the left with some bulges just below the impingement. This in neutral as that is the only position imaging has been done…I have tia’like symptoms when I turn my head, within seconds so guessing that imaging with head turned is a bad idea for more than a few seconds.

overall, I wonder about the risk of imaging with head in positions other than neutral if we are having vascular symptoms. I wish there was a really quick snapshot they could do with head turned or whatever that captured the vessels being compressed but then we can have head back in neutral straight away to avoid ischemic accident.

It’s usually the carotid arteries affected if you’re getting TIA like symptoms when your head’s in a certain position, Della. The jugular vein compression tends to cause some back up of blood inside the head- it can cause dizziness/ wobbliness, sort of drunk feeling, and you can feel pulsing, often pulsatile tinnitus.
Hopefully you’ll find out after surgery- is it still going to be done on the 20th?

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heya Jules, yes I have both carotid, ICA and jugular involvement, The ICA was picked up on Ct angio, as in “significant tortuosity” and have been having the tia’s for years and the major pressure in head, flow problems which I suspect is from the jugular. I drunk walk now for 4 years and it’s been horrid.

I am supposed to fly down next week for consult on 17th and “prospective surgery” on 20th but after speaking with surgeon who was answering phones the other day as his receptionist was away, he didn’t seem all that informed into my case and was a bit offhand about whether surgery will actually happen. Needless to say, this scares the hell outta me but I gotta keep going ya know?


Frustrating, hope that you can get surgery on the 20th, and hope he’s a bit more informed and confident when you see him! Hang in there…

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