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Your symptoms are very typical of vascular ES. The gastroparesis is likely from your vagus nerve being irritated by elongated styloids &/or calcified stylohyoid ligaments. It’s one of the cranial nerves most commonly affected by ES.
Hi, & welcome to the site!
The styloids certainly look pretty thick at the top/ skull base, so it’s certainly possible that they could be compressing the IJV where it exits the skull…I couldn’t see any calcification on the stylo-hyoid ligaments, but the styloids do look longer than average…
As you noted that your symptoms are worse with head rotation especially to the right, it may be that you have CCI (craniocervical instability), & your C-1 is “over-rotating” w/ head rotation. This won’t show up in a static scan such as a CBCT but will show in a dynamic test where images are taken with your head in different positions. Thus it may not be that your C-1 is rotated as much as it over-rotates w/ head movement. This is just speculation on my part. Mr. Hughes & Mr. Timothy have both been mentioned as doctors who diagnose CCI & both apparently do vascular decompression surgeries & styloidectomies.
I agree w/ Jules that your styloids do look thicker toward the top & the left one in particular gets very thin & needle like toward it’s lower end. The right does, too, but not to the extent of the left one. The right one also looks longer than the left to me but it might be the angle of the image I viewed.
Hi, so Mr Timothy (Neurosurgeon) can help diagnose CCI (I think). I don’t think Mr Hughes (ENT) can do that. MrT can trim C1/Mr H can remove styloid- if have JV compression issues. For CCI I began my diagnosis with Atlas Orthagonal practice in newport Shropshire. Just to clarify in case helpful. D
My original CCI diagnosis was by Prof Smith using upright MRI with head movements at Medserina in London. Sadly Prof Smith has retired to Scotland now. Unsure if there is a replacement they use.
atlas Orthagonal corrections at Newport helped my CCI. But had to have spinal fusion as became unable to hold corrections. Newport used X Rays to determine correction needed. They now have a more sophisticated scanner too.
I’d discuss with Newport if they think have CCI & if Atlas correction could help. You may already have done that.
Might be worth seeing instability physio specialist too, either Anna at Physiocure Leeds or Ann at Wellington in London. Both help instability patients and are very knowledgeable.
On scan - I guess Newport would have suggested correction if they felt could help. I do think dynamic head movement during scan is important. But for those with instability that can be difficult/painful. CCI worsens with head movement I believe.
Fusion at C1/C2 has helped me enormously. But I am still battling with JV compression/trapped fluid in skull. Am hoping my op this month will help to fix that.
It’s a bit early to say at only week 3 post op. But yes there are some positive changes. I hope JV on right side is now going to widen, as it did after op on left side, but that takes some time. Still working on wound healing getting better beneath ear & swelling that accompanies that. Know nerves will take longer to heal. I am glad I had the surgery. Biggest change so far is being able to stay upright for longer. Pulse when walking more steady & less pain behind right ear. Nights/sleep still bit tricky but slowly improving I think. D