Ischemic stroke and bilateral dissection of the internal carotid artery: A rare manifestation of the Eagle syndrome. A case report

Abstract

A syndrome characterized by cervical pain and an abnormally elongated styloid pro- cess was first described by Watt Eagle in 1937. Even though vascular Eagle syndrome is uncommon and is not well recognized as a cause for carotid artery dissection, in the last few years there have been an increasing number of case reports of carotid artery dissection caused by an elongated styloid process. A 56 years old man presented to the emergency department with acute left fa­cial weakness and slurred speech. He complained of two days neck pain, related to a coughing fit. The code stroke protocol was activated and imaging showed a right tem­poral bone stroke and a bilateral internal carotid artery dissection. A scan angiography of the supra-aortic vessels with 3D reconstruction was performed showing a bilateral abnormally elongated styloid process. The patient underwent angioplasty with two stent placements. Due to the high risk of recurrent strokes, the patient was evaluated in the otolaryngology department for styloid process resection. Finally a transoral approach for the right side and an open approach for the left side were performed. We have to consider an elongated styloid process as an important cause of carotid artery issection and subsequent cerebrovascular complications