Eagle syndrome with hidden stylocarotid syndrome examined using dynamic ultrasonography: illustrative case

Abstract

BACKGROUND Eagle syndrome, or elongated styloid process syndrome, is a rare cause of cerebral infarction. When the styloid process is elongated but the internal carotid artery (ICA) is morphologically normal on three-dimensional computed tomography angiography (3D-CTA), determining the causal relationship between elongation and cerebral infarction is difficult. OBSERVATIONS The patient was a 27-year-old man who experienced two left cerebral infarctions in 3 months. On 3D-CTA, the styloid process was elongated, but the structure of the ICA was normal. When the patient’s neck was rotated leftward, the peak systolic velocity and pulsatility index increased (shown via dynamic subtraction ultrasonography) and ICA stenosis was evident (shown via subtraction angiography). The styloid process was removed, and the cerebral infarction did not recur in the 2 years after surgery. LESSONS This is the first report to document that indirect compression of ICA by the styloid process can cause Eagle syndrome. The blood flow changes of the ICA on dynamic ultrasonography revealed morphological changes that were hidden on 3D-CTA or nondynamic subtraction angiography.

A 51-year-old man who presented with acute onset aphasia, right sided weakness - Case Report

“…11 Carotid dissection as a result of Eagle's syndrome is exceedingly rare and called Stylocarotid syndrome. [12][13][14][15][16] To date, no case of bilateral carotid dissection related to this syndrome has been reported in the literature. The diagnosis was supported in this case by demonstration of a blunting of the cerebral blood ow velocity by transcranial doppler in the right middle cerebral artery when the patient turned his head to the left (Fig.…”

Mechanical disorders of the cervicocerebral circulation in children and young adults

“…Doppler ultrasonography with head maneuvers may reveal dynamic compression of the ICA and is less prone to logistical challenges. 33 CDDSA with head maneuvers is useful in equivocal cases. Angiograms of both common carotid arteries are best performed with the head in neutral, rotated (dextro and levo), and flexed positions.…”

Transoral robotic styloidectomy for Eagle syndrome: A systematic review

“…Headaches or focal neurological symptoms, such as transient ischemic attacks or strokes, may occur in the clinical presentation of Eagle syndrome known as stylocarotid syndrome. This occurs when the elongated and deviated styloid process impacts and runs above the internal carotid artery 5 …”

“…This occurs when the elongated and deviated styloid process impacts and runs above the internal carotid artery. 5 The styloid process is defined as elongated when longer than 30 mm, and this condition has a prevalence that can reach 33.4% of the population, but only a few cases become symptomatic. 6 It can be unilateral or bilateral, as described in literature.…”