A Staged Therapy for Internal Carotid Artery Dissection Caused by Vascular Eagle Syndrome

Torikoshi, Sadaharu; Yamao, Yukihiro; Ogino, Eiji; Taki, Waro; Sunohara, Tadashi; Nakagawa, Masaki

doi:10.1016/j.wneu.2019.05.208

Cited by 24 publications

(30 citation statements)

References 20 publications

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“…Eagle syndrome may cause carotid artery disease, including vessel stenosis, artery dissection, or pseudoaneurysm, and may be complicated by cerebrovascular events [ 3 ]. Bilateral carotid dissection from ES is rare, and only a few cases are reported in the available literature ( Supplementary Table 1 ) [ [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] ]. As previously reported, there exists a strong male predominance on carotid dissection cases secondary to ES [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous case series have documented high rates of recurrent infarcts in patients with ICA dissection secondary to ES [ 9 ]. We identified 12 cases of bilateral carotid dissection secondary to ES [ [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] ]. Of the cases identified, 7 documented an acute ischemic strokes on admission [ 4 , 5 , [7] , [8] , [9] , [10] , 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Bilateral carotid dissection due to Eagle syndrome in a young female

et al. 2021

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Eagle syndrome (ES) is a rare clinical syndrome characterized by the elongation of the temporal bone's styloid process, or calcification of stylohyoid ligament, compressing surrounding structures causing pharyngalgia. One of its variants, the styloid-carotid artery syndrome, produces symptoms by compression of the external or internal carotid arteries (ICA). Here, we present a case of a 43-year-old woman with ES and bilateral ICA dissections. The patient underwent staged bilateral angioplasty and covered stent placement, followed by styloidectomy. A computerized tomography angiogram revealed patency of both stents at a two-year follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bilateral carotid dissection due to Eagle syndrome in a young female

et al. 2021

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“…Although the incidence of an elongated styloid process itself is between 4 to 7%, the incidence of vascular Eagle syndrome is extremely rare [ 1 ], and clinicians occasionally misdiagnose it as idiopathic ICA dissection. Because ICA dissection caused by vascular Eagle syndrome has a higher recurrence rate than idiopathic ICA dissection [ 2 ], clinicians should consider vascular Eagle syndrome when diagnosing ICA dissection.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment strategy was controversial because there was no case of coexisting Eagle syndrome and vascular EDS. In cases of carotid artery dissection due to Eagle syndrome, either surgical resection of the elongated styloid process or carotid artery stenting are sometimes conducted [ 2 ]. On the other hand, in patients with vascular EDS, the surgical intervention is thought to be harmful or sometimes life-threatening because of the vascular vulnerability, instead that arterial dissection is a well-known vascular complication among them [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…This suggests ICA dissection due to Eagle syndrome in vascular EDS could be safely observed without surgical intervention. Since half of the cases of arterial dissection caused by Eagle syndrome did not recur or deteriorate without surgical intervention [ 2 ], close follow-up should be prioritized in the coexistence of Eagle syndrome and vascular EDS, and surgical intervention should be restricted only in vascular EDS cases with the life-threatening situation [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

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Bilateral carotid artery dissection due to Eagle syndrome in a patient with vascular Ehlers-Danlos syndrome: a case report

et al. 2020

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Background Patients with vascular Ehlers-Danlos syndrome (EDS) occasionally suffer from arterial dissection. Eagle syndrome, which is caused by an elongated styloid process and also causes arterial dissection, is difficult to diagnose and could sometimes be overlooked. Little is known of the coexistence of these two diseases, and treatment strategy is not established. Here, we present a case of bilateral internal carotid artery (ICA) dissection due to Eagle syndrome in a patient with vascular EDS. Case presentation A 30-year-old man was admitted to our hospital because of sudden onset of mild sensory disturbance in his left limbs. He had a history of Ehlers-Danlos syndrome (EDS) and also had left cervical internal carotid artery (ICA) dissection 3 years before. Diffusion-weighted imaging showed acute cerebral infarcts in the right hemisphere. Cervical computed tomography angiography (CTA) revealed the right ICA narrowing at the cervical portion in addition to the previous left cervical ICA dissection. Cervical magnetic resonance imaging (MRI) revealed double-lumen and intramural hematoma at the narrowing portion of the right cervical ICA, which indicates arterial dissection. CT also revealed bilateral elongated styloid processes which are close to each side of cervical ICA. We diagnosed him as bilateral ICA dissection due to bilateral Eagle syndrome. Considering vascular complications due to vascular EDS, we performed closer follow-up with transoral carotid ultrasonography (TOCU). In 4 months, his right ICA dissection gradually improved without stroke recurrence or deterioration of dissection. Conclusions Since patients with vascular EDS easily develop arterial dissection, Eagle syndrome may be overlooked. Clinicians should consider Eagle syndrome in the case of vascular EDS with extracranial ICA dissection and close follow-up should be prioritized in cases of Eagle syndrome with vascular EDS.

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