Dissection of the internal carotid artery: A rare complication of the Eagle syndrome

Introduction:

The Eagle syndrome, also termed stylohyoid syndrome or styloid syndrome, is a rare pathological elongation of the styloid process which mostly leads to sharp nerve-like pain in the lateral throat and tongue region. A cerebral infarction in the territory of the middle cerebral artery as a result of a dissection of the internal carotid artery (ICA) has not been described yet.

Methods:

We present a rare case of a 43-year-old patient who has been introduced to us with neurological deficits and dissection of the right ICA. A computed tomography of the head and neck performed for further diagnosis of a suspected infarction in the territory of the middle cerebral artery of the right side, showed a two-sided high-cervical dissection of the ICA being the cause for the thromboembolism. Furthermore, a dramatically enlarged styloid process was found on both sides in direct contact to the ICAs dissection.

Results:

Due to the direct contact to the elongated styloid process on both sides, there was a high degree of suspicion that its carotid close end caused the dissections of the ICA. Therefore, despite the infarction in the territory of the right middle cerebral artery being only one-sided, we performed the resection of the styloid process on both sides.

Conclusions:

In rare cases, an elongation of the styloid process may lead to neurological complications during a mechanical irritation and injury of the neck vessels (in this case the right ICA). A prophylactic resection of a significantly elongated styloid process may therefore be useful to avoid future complications.

Publication History

Publication Date:
23 April 2019 (online)