Traumatic injury to the internal carotid artery by the hyoid bone: a rare cause of ischemic stroke

Abstract

Central nervous system (CNS) ischemic events, besides being a common and devastating disease, are accompanied by severe disability and other morbidities. The cause of such events is not always that simple to diagnose, and among the young, a broad spectrum of possibilities should be considered. We present the case of a young man who presented two episodes of CNS ischemia with a 1 year gap between them, which occurred in the same situation while he was walking and carrying a heavy backpack. The second event first presented as a transient ischemic attack followed by a stroke the day after. The diagnostic work-up showed an indentation of the greater cornu of the hyoid bone over the internal carotid artery, which injured the media and intimal layers. At the arterial injury site, a micro thrombus was found, which explained the source of the embolic event to the CNS. The patient was operated on, and the procedure included the resection of the posterior horn of the hyoid bone, the resection of the injured segment of the internal carotid artery followed by carotid–carotid bypass with the great saphenous vein. The postoperative period and the recovery were uneventful as was the 5-month follow-up. We call attention to this unusual cause of stroke and present other cases reported in the literature.

Hyoid bone impingement contributing to symptomatic atherosclerosis of the carotid bifurcation

“…Its position in the neck relative to the carotid arteries can shift, as evidenced by reports of arterial injury by the hyoid bone after repetitive trauma, such as carrying heavy weights and playing golf. 2,8,12 The compression of the carotid artery by the hyoid can cause abrupt geometric wall changes to the artery that result in disturbed flow and high wall shear stress gradients. 13 The susceptibility to atherosclerosis at the carotid bifurcation, a location where the vessel geometry changes from straight to branched, is an example of the correlation between wall stress and atherosclerosis.…”

“…Symptomatic carotid artery disease caused by hyoid bone intrusion is an extremely rare phenomenon. Scant reports have detailed the cerebrovascular events due to mechanical interference of the hyoid bone on the carotid artery leading to entrapment, 1-3 embolism, [4][5][6][7][8][9] dissection, 6,10 atherosclerotic stenosis, 11 and pseudoaneurysm formation. 12 In some cases of embolism or dissection, the patients were treated medically, 4,7,10 whereas other patients with compression, pseudoaneurysm, or stenosis underwent surgical management with partial resection of the hyoid bone.…”

Carotid Endarterectomy Requiring Removal of the Superior Horn of Thyroid Cartilage: Case Report and Literature Review

“…10) We found that 17 ACVS cases due to HB obstruction have been reported previously. Among these reports, we summarized cases in which we identified the running course of the ICA (medial or lateral to ECA) and the positional relationship between HB and ICA 1,[11][12][13][14][15][16][17][18][19][20][21][22] (Table 1). Among 14 cases, seven cases had twisted carotid bifurcations, and in all the cases the greater horn of HB was located lateral to the ICA.…”