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

Author:

Tanaka Yukiko12,Anami Hidenori12,Kurihara Hiroyuki12,Miyao Satoru12,Nakamoto Hidetoshi12,Kubota Yuichi12,Kawamata Takakazu2

Affiliation:

1. Department of Neurosurgery and Stroke Center, TMG Asaka Medical Center, Saitama, Japan; and

2. Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan

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.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Management Science and Operations Research,Mechanical Engineering,Energy Engineering and Power Technology

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