Ross Hauser, M.D.
Dynamic carotid sheath compression (DCSC) occurs when the carotid sheath is compressed with certain head and neck positions, pinching and compressing the functions of the internal jugular veins, the vagus, glossopharyngeal, and spinal accessory cranial nerves, the sympathetic plexus of nerves, and the carotid arteries. Dynamic carotid sheath compression may impact every system in the body, causing a myriad of body and brain symptoms and diseases, especially through the vagus nerve dysfunction/degeneration and internal jugular vein compression it causes.
The carotid sheath encases the carotid artery, jugular vein, vagus nerve, and the sympathetic plexus of nerves. The instability of the cervical spine can cause compression on the carotid sheath due to its location around the vertebrae. The cervical compression can cause arterial ischemia (inadequate blood flow to the brain), leading to drop attacks, brain fog, and other symptoms.
The interconnections between the nerves are of great clinical importance. Instead of right off the bat thinking of doing surgery for a symptom that may be related to the autonomic nervous system, such as recurrent laryngeal nerve irritation causing hoarseness or swallowing difficulty, first evaluate to see if there is cervical instability present. causing compression on the carotid sheath.
A list of potential disorders includes:
- whiplash-associated conditions
- post-concussion syndrome
- migraine headaches
- head pressure
- vertigo
- Meniere’s disease
- tinnitus
- dizziness
- hypersensitivity syndromes
- eye/hearing distortions
- semicircular canal dehiscence
- postural orthostatic tachycardia syndrome
- mast cell activation syndrome
- brain fog
- personality changes
- cervical radiculopathy
- swallowing difficulties
- An example is a patient who had a lot of pain with swallowing that was relieved when not swallowing. Again, this symptom was not there 24/7; it had to do with a specific activity. When the swallowing muscles are activated, the person’s symptoms increase. As it turns out, most of the nerves that supply the muscles for swallowing reside in the carotid sheath, including the vagus nerve. This patient was found to have an enlarged vagus nerve on the right side, presumed to be from long-standing cervical instability. The patient received a combination of Prolotherapy for their upper cervical instability, along with NRIT (nerve release injections) to the carotid sheath area (released cranial nerves 9-12) and PRP injected into and around the same nerves. Over several months and treatments, her symptoms lessened drastically.
- and a host of unresolved internal organ dysfunctions
In the image above, the various causes of Dynamic carotid sheath compression are illustrated:
- Ligamentous upper cervical instability
- Ligamentous lower cervical instability
- Mandibular malposition
- Forward head posture
- Excessive thoracic kyphosis
- Cervical dysstructure
- Elongated styloid
Stretch and compression of the glossopharyngeal nerve, spinal accessory nerves, and vagus nerve
While brain structure and function can be severely affected by dynamic carotid sheath compression, other symptoms can develop and present themselves from stretch and compression of the
glossopharyngeal nerve, spinal accessory nerves, and vagus nerve. Cervical musculoskeletal symptoms, such as neck tension and tightness of the sternocleidomastoid or trapezius muscle, are common and could occur because of spinal accessory nerve (cranial nerve XI) irritation from ligamentous cervical instability, as both muscles are innervated by it. Cervical dystonia and torticollis could have their origins and causes in spinal accessory nerve irritation/dysfunction, initiating one-sided sternocleidomastoid or trapezius tension or contraction, pulling the head to one side (or the sensation of it). Spinal accessory nerve denervation or decompression are traditional treatments for these conditions.
The glossopharyngeal nerve, cranial nerve IX, innervates muscles that are involved in elevating the larynx and pharynx, especially during speaking and swallowing, and carries sensory (general visceral afferent) information from the carotid sinus and body about blood pressure, blood oxygen, and CO2 levels. It is the sensory branch of the gag reflex, and when the gag reflex is tested by hitting the back of the throat gently with a tongue blade, many people have an absent or diminished reflex. Swallowing difficulties, such as feeling like food gets caught somewhere in the throat, frequent aspirations of food, painful swallowing, throat pain, orthostatic symptoms, and dysautonomia (through blood pressure dysregulation) can stem from glossopharyngeal nerve dysfunction related to dynamic carotid sheath compression from ligamentous cervical instability. The swallowing issues can be documented by a barium swallow study.