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Berrada K, El Ouali I, Zahi H, Fikri M, Jiddane M, Touarsa F. Bilateral carotid dissection due to Eagle syndrome. Radiol Case Rep 2024; 19:927-933. [PMID: 38188950 PMCID: PMC10767265 DOI: 10.1016/j.radcr.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 01/09/2024] Open
Abstract
Eagle syndrome is defined as a collection of symptoms affecting the cervical and cranial regions, resulting from an elongated styloid process or ossified stylohyoid ligament encroaching on surrounding structures and causing a variety of symptoms. Classically, Eagle syndrome presents as neck, throat, or ear pain. Carotid artery dissection is a rare complication of Eagle syndrome. We report the case of a 40-year-old man who presented with bilateral internal carotid artery dissection secondary to pathological elongation of the styloid processes.
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Affiliation(s)
- Kenza Berrada
- Department of Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Ibtissam El Ouali
- Department of Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Hiba Zahi
- Department of Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Meriem Fikri
- Department of Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Mohamed Jiddane
- Department of Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Firdaouss Touarsa
- Department of Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
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2
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Vigilante N, Khalife J, Badger CA, Shaikh H, Thomas AJ, Swendseid B, Jovin TG, Siegler JE, Tonetti DA. Surgical management of stylocarotid Eagle syndrome in a patient with bilateral internal carotid artery dissection: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE23682. [PMID: 38285978 PMCID: PMC10829260 DOI: 10.3171/case23682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/26/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Eagle syndrome is characterized by an elongated styloid process, which can cause acute neurological symptoms when the projection impinges on local structures. One method by which Eagle syndrome can cause acute stroke is via internal carotid artery dissection. OBSERVATIONS A patient presented with acute aphasia and right-arm weakness. Imaging revealed a left internal carotid artery dissection, which was treated with stenting. Three years later, the patient presented with left-sided weakness, and imaging revealed a new right internal carotid artery dissection. Closer review of the patient's imaging revealed bilateral elongated styloid processes. The patient subsequently underwent staged bilateral styloidectomy and returned to his prior baseline postoperatively. LESSONS This case report describes a patient with Eagle syndrome who had two internal carotid artery dissections separated by several years. A literature review revealed that styloidectomy is well tolerated in patients with carotid dissection due to Eagle syndrome. Patients with carotid dissection due to Eagle syndrome remain at risk for contralateral dissection, and prophylactic contralateral styloidectomy should be considered.
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Affiliation(s)
| | - Jane Khalife
- 1Cooper Medical School of Rowan University, Camden, New Jersey
- 2Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
| | - Clint A Badger
- 1Cooper Medical School of Rowan University, Camden, New Jersey
- 3Department of Neurosurgery, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
| | - Hamza Shaikh
- 1Cooper Medical School of Rowan University, Camden, New Jersey
- 3Department of Neurosurgery, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
| | - Ajith J Thomas
- 1Cooper Medical School of Rowan University, Camden, New Jersey
- 3Department of Neurosurgery, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
| | - Brian Swendseid
- 1Cooper Medical School of Rowan University, Camden, New Jersey
- 4Division of Otolaryngology - Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey; and
| | - Tudor G Jovin
- 1Cooper Medical School of Rowan University, Camden, New Jersey
- 2Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
| | - James E Siegler
- 5Department of Neurology, University of Chicago, Chicago, Illinois
| | - Daniel A Tonetti
- 1Cooper Medical School of Rowan University, Camden, New Jersey
- 2Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
- 3Department of Neurosurgery, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
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Halalmeh DR, Vrana A, Mercer L, Moisi M. Traumatic Eagle's Syndrome: A Rare Cause of Neck Pain and Headache in Trauma Patients. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942595. [PMID: 38263689 PMCID: PMC10825704 DOI: 10.12659/ajcr.942595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/19/2023] [Accepted: 11/29/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Eagle syndrome can be a rare cause of neck pain and headache. The elongated styloid process typically irritates and compresses adjacent neurovascular structures in the neck, leading to insidious signs and symptoms classic of Eagle syndrome. However, neck pain after traumatic events can be the only sign of elongated styloid processes. Therefore, knowledge of this syndrome is necessary to prevent misdiagnosis and futile attempts at treatment, especially in the setting of trauma. CASE REPORT In this article, we report the case of a 20-year-old man who presented with throbbing neck pain and headache immediately after a motor vehicle accident. The patient's symptoms did not improve with analgesics and muscle relaxants. He was then admitted for overnight monitoring while awaiting computed tomography imaging of the head and neck, which revealed elongated styloid processes on both sides. CONCLUSIONS One of the most challenging aspects of diagnosing Eagle syndrome is the need for high clinical suspicion combined with adequate understanding of the neck anatomy and its structures. Owing to the proximity of the elongated styloid process to important neurovascular structures, such as the carotid arteries and vagus nerve, early diagnosis of Eagle syndrome is necessary to guide the clinical decision-making and provide optimal care for patients.
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Affiliation(s)
- Dia R. Halalmeh
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, MI, USA
| | - Antonia Vrana
- College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Leo Mercer
- Department of Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Marc Moisi
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, MI, USA
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Pagano S, Ricciuti V, Mancini F, Barbieri FR, Chegai F, Marini A, Marruzzo D, Paracino R, Ricciuti RA. Eagle syndrome: An updated review. Surg Neurol Int 2023; 14:389. [PMID: 38053694 PMCID: PMC10695462 DOI: 10.25259/sni_666_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/16/2023] [Indexed: 12/07/2023] Open
Abstract
Background This work aims to review the current literature and our experience on vascular Eagle syndrome (ES) that can present misleading clinical presentations and better understand the possible therapeutic strategies. Methods We reviewed the existing literature on PubMed from January 1, 2017, to December 31, 2022, including the sequential keywords "vascular AND Eagle syndrome," "vascular AND styloid syndrome," "vascular AND elongated styloid process," "vascular AND stylocarotid syndrome," and "Eagle syndrome AND carotid artery dissection." Results 38 vascular ES cases, including our experience, were analyzed. The most frequent clinical onset was hemiparesis (n 21, 57%), but other regular clinical presentations were aphasia, loss of consciousness, amaurosis, headache, or a combination of the latter. Massive oral bleeding was reported only once in the literature before our case. Twelve patients were treated with only antiplatelet therapy, either single or double. Nine patients were treated with anticoagulation therapy only. In 14 patients, a carotid artery stent was used, associated with anticoagulation or antiplatelet therapy. In 17 cases, a styloid process (SP) resection was performed. Conclusion ES has many clinical presentations, and carotid artery dissection resulting in oral bleeding seems rare. Literature results and our experience make us believe that when dealing with vascular ES, the best treatment strategy is endovascular internal carotid artery stenting with antiplatelet therapy, followed by surgical removal of the elongated SP to prevent stent fracture.
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Affiliation(s)
- Serena Pagano
- Department of Neurosurgery, Ospedale Belcolle, Viterbo, Italy
| | - Vittorio Ricciuti
- Department of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Gerardo dei Tintori, Monza, Italy
| | - Fabrizio Mancini
- Department of Neurosurgery, Azienda Ospedaliera Di Perugia, Perugia, Italy
| | | | - Fabrizio Chegai
- Department of Vascular and Interventional Radiology, Unit of Radiology, Ospedale Belcolle, Viterbo, Italy
| | - Alessandra Marini
- Department of Neurosurgery, Azienda Ospedaliera Di Perugia, Perugia, Italy
| | | | - Riccardo Paracino
- Department of Neurosurgery, Azienda Ospedaliera Di Perugia, Perugia, Italy
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Sarwar MU, Furrukh M, Tabrez MA, Kannar A, Sumbal MA, Haseeb M. Malignant Middle Cerebral Artery Infarct Caused by Eagle's Syndrome. Cureus 2023; 15:e47205. [PMID: 38022111 PMCID: PMC10653012 DOI: 10.7759/cureus.47205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Eagle's syndrome is characterised by elongation of the styloid process. The elongated styloid process can cause symptoms like dysphagia, facial or neck pain, syncope, visual changes, etc. In severe cases, it may cause a rupture or dissection of the carotid artery, which can lead to intracranial thrombo-embolism and ischemic stroke. We report a case of a 57-year-old male presenting with dysarthria and mild left-sided body weakness. An initial non-contrast computed tomography (CT) scan showed a possible right internal carotid artery thrombus. He developed worsening left-sided weakness and gaze palsy one day after the admission. Repeated CT brain and intracranial angiography were arranged, which showed significant oedema with mass effect and right internal carotid artery dissection with thrombus. He underwent decompressive craniectomy. An enlarged styloid process measuring 4.53 cm in close proximity to the cervical vasculature was also noted. He was not deemed an appropriate candidate for styloidectomy. Due to residual left-sided weakness, he had to take early retirement. He underwent extensive rehabilitation and was able to mobilize with the help of a quad stick after a period of nine months. At the five-year follow-up, there were no characteristic symptoms of Eagle's syndrome and he was mobilizing without support.
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Affiliation(s)
| | | | | | - Aqil Kannar
- General Medicine, Dorset County Hospital, Dorchester, GBR
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Swanson D, Evensky CH, Yusuf S, Long H, Hasoon J, Mohamed M, Dixon BM, Parker-Actlis T, Alvarado MA, Song J, Kaye AM, Varrassi G, Kaye AD, Ganti L. Eagle Syndrome: Pathophysiology, Differential Diagnosis and Treatment Options. Health Psychol Res 2023. [DOI: 10.52965/001c.67851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
The present investigation summarizes relevant symptoms, differential diagnosis, imaging, and treatment options of Eagle Syndrome. A comprehensive literature review of peer-reviewed literature was employed utilizing most relevant databases. The diagnoses of Eagle Syndrome have recently increased because of increased awareness of physicians of Eagle Syndrome and the earlier identification of the cardinal symptoms of the disease. The most important symptoms are dysphagia in the setting of cervical neck pain, but there is a wide variety of symptomatology that make Eagle Syndrome a challenge to recognize and diagnose clinically. CT scan continues to be the standard of care for diagnosing Eagle Syndrome and CT Angiography has an important role in aiding diagnosis as well. Medical treatment options include steroids, antidepressants, and anticonvulsants however not all cases of Eagle Syndrome can be managed medically. Surgical approaches are varied but typically are either extraoral or transoral. This report aims to update providers on the important diagnostic criteria of Eagle Syndrome and how physicians can develop a treatment plan that addresses all the symptoms of patients with Eagle Syndrome because it can be treated safely and appropriately.
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Affiliation(s)
- Daniel Swanson
- Georgetown University School of Medicine, Washington, DC
| | | | | | | | - Jamal Hasoon
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Mustafa Mohamed
- HCA Florida Osceola Hospital & University of Central Florida College of Medicine, Orlando, FL Orlando, FL
| | | | | | | | - Jaehong Song
- Georgetown University School of Medicine, Washington, DC
| | - Adam M. Kaye
- Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA
| | - Giustino Varrassi
- Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Alan D. Kaye
- Louisiana State University Shreveport, Shreveport, LA
| | - Latha Ganti
- HCA Florida Osceola Hospital & University of Central Florida College of Medicine, Orlando, FL Orlando, FL
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Selvadurai S, Williamson A, Virk JS, Clarke P. Eagle syndrome and carotid artery dissection: a rare skull base cause of stroke. BMJ Case Rep 2022; 15:e247954. [PMID: 35264386 PMCID: PMC8915306 DOI: 10.1136/bcr-2021-247954] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/03/2022] Open
Abstract
Eagle's syndrome is a rare collection of symptoms that occur secondary to an elongated styloid process or calcified stylohyoid ligament irritating its surrounding structures. Classically, this presents as unilateral throat pain or rarely, as acute neurological symptoms secondary to compression of the internal carotid artery: so called 'stylocarotid syndrome'. Significant neurological events in teenagers, secondary to Eagle syndrome have not been reported. We discuss the rare case of a teenage boy, diagnosed with right internal carotid artery dissection and middle cerebral artery infarction, with no cause initially identified. Following further admission with a transient neurological episode, he was noted to have elongated styloid processes with the right abutting the site of carotid dissection. He underwent styloidectomy and has since remained symptom free. This case highlights the importance of considering anatomical variants when assessing young patients with neurological symptoms, and the potential morbidity and mortality benefit that early surgical intervention may have.
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Affiliation(s)
| | | | - Jagdeep S Virk
- Otolaryngology, Barts Health NHS Trust, London, UK
- Otolaryngology, Charing Cross Hospital, London, UK
| | - Peter Clarke
- Otolaryngology, Charing Cross Hospital, London, UK
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8
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Melchenko SA, Golodnev GE, Gumin IS, Tairova RT, Senko IV. [Dissection of brachiocephalic arteries as a complication of open neurosurgery: case report and literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:83-91. [PMID: 35758083 DOI: 10.17116/neiro20228603183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Abnormal styloid processes cause dissection of supra-aortic arteries in some cases. In total, about 33 cases have been described in the world and national literature. However, there were no dissections associated with neurosurgery. At the same time, anomalies of styloid process may be an unidentified cause of many spontaneous dissections of brachiocephalic arteries. OBJECTIVE To analyze modern data on dissection of brachiocephalic arteries associated with anomalies of styloid process and describe dissection in a 44-year-old patient with deviated styloid processes after posterior cranial fossa surgery. MATERIAL AND METHODS Searching for literature data was performed using the keywords "dissection of the cervicocerebral arteries", "dissection of the brachiocephalic arteries", "stylocarotid syndrome" and "Eagle syndrome" in the PubMed and Medscape databases. We also describe a patient hospitalized for microsurgical resection of cystic-solid hemangioblastoma of medulla oblongata who developed postoperative dissection of both internal carotid and vertebral arteries. RESULTS We found 1777 papers between 01/01/1900 and 01/18/2021. In most cases, ICA dissection was not a result of stylocarotid syndrome. There were 121 full-text Russian- or English-language articles. We selected 46 most relevant publications. Analyzing these papers, we found that small distance between the tops of styloid processes and internal carotid arteries can be a risk factor of dissection of brachiocephalic arteries in addition to styloid process elongation. Our patient was diagnosed with just such an anomaly. CONCLUSION Anomalies of styloid processes can cause dangerous vascular complications. Therefore, the length and abnormal deviation of styloid process should be considered when planning intraoperative position of a patient associated with prolonged neck flexion.
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Affiliation(s)
- S A Melchenko
- Federal Center of Brain and Neurotechnologies, Moscow, Russia
| | - G E Golodnev
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - I S Gumin
- Federal Center of Brain and Neurotechnologies, Moscow, Russia
| | - R T Tairova
- Federal Center of Brain and Neurotechnologies, Moscow, Russia
| | - I V Senko
- Federal Center of Brain and Neurotechnologies, Moscow, Russia
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Tanti M, Smith A, Warren DJ, Idrovo L. Internal carotid artery dissection due to elongated styloid process. BMJ Case Rep 2021; 14:e245908. [PMID: 34479906 PMCID: PMC8420707 DOI: 10.1136/bcr-2021-245908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Matthew Tanti
- Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Aubrey Smith
- Department of Neuroradiology, Hull Royal Infirmary, Hull, UK
| | - Daniel J Warren
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Luis Idrovo
- Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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10
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Traumatic Events and Eagle Syndrome: Is There Any Correlation? A Systematic Review. Healthcare (Basel) 2021; 9:healthcare9070825. [PMID: 34209816 PMCID: PMC8307160 DOI: 10.3390/healthcare9070825] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Eagle syndrome occurs when elongated styloid process or ossification of the stylohyoid ligament interfere with the surrounding anatomical structures giving rise to various symptoms. Watt W. Eagle identified two types: stylo-hyoid classic syndrome and stylo-carotid artery syndrome. The aim of this systematic review of the literature is to evaluate correlations between Eagle syndrome and traumatic events or teeth extractions. Methods: out of 294 articles, the final study allowed the identification of 13 studies focusing on traumatic events. Out of 342 articles, the final study allowed the analysis of two studies regarding extractive dental events. Results: 13 articles showed correlations between the onset of symptoms in Eagle syndrome and traumatic events and highlighted two possibilities: traumatic event could fracture the already elongated styloid process or calcified stylohyoid ligament; trauma itself triggers the pathophysiological mechanisms that lead to lengthening of styloid process or calcification of stylohyoid ligament and therefore the typical symptoms. The only two case reports concerning Eagle syndrome symptoms after extractive dental events describe the onset of classic type. Conclusions: The analyzed articles confirm correlation between traumatic event and onset of typical symptoms of Eagle syndrome. There is not enough literature linking extractive dental events to Eagle syndrome. Trial registration: CRD42020185176.
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Duarte-Celada WR, Jin D, Neves G, Windisch T. Bilateral carotid dissection due to Eagle syndrome in a young female. eNeurologicalSci 2021; 24:100353. [PMID: 34195395 PMCID: PMC8239458 DOI: 10.1016/j.ensci.2021.100353] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/14/2021] [Indexed: 11/26/2022] Open
Abstract
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. Bilateral carotid artery dissection due to Eagle Syndrome is extremely rare. Limited evidence exists on the management of styloid-carotid artery syndrome. There is a strong male predominance and high rates of infarcts on this entity. Endovascular treatment in the acute phase may help reduce new/recurrent strokes.
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Affiliation(s)
| | - Dongkwan Jin
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Gabriel Neves
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Thomas Windisch
- Department of Interventional Radiology, Covenant Medical Center, Lubbock, TX, USA
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12
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Xhaxho S, Vyshka G, Kruja J. Eagle syndrome presenting as a neurological emergency: A case report. Surg Neurol Int 2021; 12:257. [PMID: 34221588 PMCID: PMC8247754 DOI: 10.25259/sni_362_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/19/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Eagle syndrome, due to the elongation of the styloid process as well as the calcification of the stylohyoid ligament, rarely presents itself with a major neurological disorder such as a brain infarct. CASE DESCRIPTION Authors describe the case report of a previously healthy 64-year-old Caucasian male that complained of inability to control his right upper and lower extremity of an acute nature. Imaging at the emergency department (magnetic resonance of the brain and computerized angiography) showed the presence of elongated styloid process bilaterally with clear predomination at the left side. The brain ischemia (left temporal brain infarct) was due to carotid artery dissection, and the left internal carotid artery was not visualized during the contrast-enhanced angiography. The patient was hospitalized at a neurological facility and thereafter referred to surgery for styloidectomy. CONCLUSION The present case underscores the need for a prompt diagnosis and an enhanced awareness of this syndrome, especially among emergency department professionals.
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Affiliation(s)
- Sokrat Xhaxho
- Department of Neurology, Mother Theresa University Hospital Center, Tirana, Albania
| | - Gentian Vyshka
- Department of Biomedical and Experimental Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Jera Kruja
- Department of Neurosciences, Faculty of Medicine, University of Medicine, Tirana, Albania
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Cruddas L, Joffe M, Baker D. Can Styloid Process and Internal Carotid Artery Anatomy be Used to Predict Carotid Artery Dissection? Ann Vasc Surg 2021; 74:105-110. [PMID: 33549788 DOI: 10.1016/j.avsg.2020.12.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Carotid artery dissection is a common cause of stroke in the young. It has been related to the association of the carotid artery with fixed neighboring anatomical structures. This study assesses the association between styloid process length, internal carotid artery position and cervical carotid artery dissection (CCAD). This information would provide potential predicative radiological measurements, which could prevent delays in CCAD diagnosis. METHODS Retrospective data was collected from 2 central London hospitals over 5 years. CCAD cases were identified from individuals who underwent computer topography angiography of the neck for suspected CCAD. The following data was collected: evidence of CCAD; bilateral styloid process length and presence of styloid-hyoid ligament calcification; bilateral styloid process-internal carotid distance; calcification of carotid arteries and whether their position was aberrant. Cases were dissection-side, age and gender matched with two non-dissection controls. RESULTS Three hundred and fifty-five individuals were identified. Fifty individuals had CCAD, of which 4 had bilateral dissection. In individuals with CCAD, average styloid process length was 27.5 mm and styloid process-internal carotid distance was 5.14 mm. There was no significant association between styloid process length or styloid process-internal carotid distance, and CCAD when compared with matched controls. Internal carotid artery aberrancy was significant for nondissection. CONCLUSIONS In this study, there was no association between styloid process length and styloid process-internal carotid distance with CCAD. These measurements can not be used to predict the possibility of a CCAD following trauma.
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Affiliation(s)
| | | | - Daryll Baker
- Royal Free Hospital, London, United Kingdom; University College Hospital, London, United Kingdom
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14
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Lau JSK, Kan PG. A distressingly painful neck. HONG KONG J EMERG ME 2019. [DOI: 10.1177/1024907919885553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Neck pain is a common complaint in the emergency department. It is often attributed to sprain and strain, and cervical spine degeneration. However, when the pain is prolonged, refractory to treatment and not improved after multiple consultations, an alternate diagnosis should be considered.
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Affiliation(s)
- James Siu Ki Lau
- Accident and Emergency Department, Ruttonjee Hospital, Wan Chai, Hong Kong
| | - Pui Gay Kan
- Accident and Emergency Department, Ruttonjee Hospital, Wan Chai, Hong Kong
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