A rare cause of atypical facial pain

Abstract

This case illustrates a rare cause of facial pain due to glossopharyngeal neuralgia in a 66-year-old male patient. Imaging confirmed an aneurysm of the cervical internal carotid artery as the cause; the aneurysm itself, likely secondary to an elongated styloid process (Eagle's syndrome). The imaging findings and management options are discussed below.

Fig. 1

Coronal T2 W MR image through the neck demonstrates a bilobar mass, appearing of signal void (A), in the upper right neck near the skull base, the internal carotid artery can be seen entering and leaving the lesion (B).

Fig. 2

Coronal CT angiographic image demonstrates a normal calibre right internal carotid artery (A) proximal and distal to the aneurysm (B). Note elongated right styloid process (C) which impinges upon the aneurysm waist. Normal left internal carotid artery (D) with prominent left styloid process also present, although this appears remote from the vessel on this side.

Fig. 3

Multiplanar reformat (MPR) sagittal oblique image to show the cervical right carotid system confirms bilobar aneurysmal dilatation (A), normal calibre proximal and distal internal carotid artery (B), external carotid (C).