Bilateral carotid dissection due to Eagle syndrome

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.

Keywords: Carotid dissection; Eagle syndrome; Elongated styloid process.

Fig. 1.

Axial sections of the brain scan performed after 6 hour showing a deep junctional stroke at the level of the corona radiata (A), at the level of the superficial posterior right (B) and posterior left (C) junctional territories.

Fig. 2.

Following the context of bilateral ischemic stroke in a young adult, initially a CT angiography of the supra-aortic trunks in search of a carotid dissection was performed showing reduced opacification of both extra-cranial internal carotid arteries more marked to the left on the axial sections (A: yellow arrows) and coronal reconstructions (B: red arrow and C: blue arrow).

Fig. 3.

CT scan bone reconstructions were essential for the search for the elongated styloid process measuring 4 cm on the right (A–C, yellow arrow) and 3.8 cm on the left (B, blue arrow).

Fig. 4.

A cerebral MRI confirmed junctional strokes on the diffusion sequence (A and B), with subacute parietal hematomas at the level of internal carotid arteries on the sequence of axial T1 fat sat (C and D) as well as the lack of opacification on the sequence of flow 2 TOF achieving the flaming appearance testifying to the subtotal occlusion.