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Liu B, Li Q, Zheng Y, Cai J, Jin H, Lin Y, Wang Y. Ischemic stroke due to stylocarotid artery syndrome: a case report and review. J Int Med Res 2024; 52:3000605241253745. [PMID: 38770565 PMCID: PMC11110523 DOI: 10.1177/03000605241253745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
Stylocarotid artery syndrome (SAS) is a rare variant of Eagle's syndrome that may lead to transient ischemic attack or stroke. The underlying pathophysiological mechanism involves compression of the internal carotid artery by an elongated styloid process (ESP), potentially resulting in vascular occlusion or dissection. An ESP exceeding 2.5 cm is deemed elongated, with a length of 3.0 cm considered clinically significant. Although the prevalence of ESP ranges from 4.0% to 7.3%, symptomatic cases are rare; symptoms are present in only approximately 4.0% of individuals with an ESP. Unlike the typical symptoms of Eagle's syndrome, SAS may not cause pharyngeal discomfort, the sensation of a foreign body in the throat, dysphagia, or facial pain. This absence of characteristic symptoms as well as the development of central nervous system symptoms often leads patients to seek care from neurologists instead of otolaryngologists, increasing the likelihood of misdiagnosis or underdiagnosis. We herein report a unique case of ischemic stroke caused by SAS and present a literature review on cases of SAS-associated ischemic stroke published in the past decade. The reporting of this study conforms to the CARE guidelines.
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Affiliation(s)
- Bin Liu
- Department of Neurology, Punan Hospital, Shanghai, China
| | - Qiuju Li
- Department of Neurology, Punan Hospital, Shanghai, China
| | - Yunyun Zheng
- Department of Neurology, Punan Hospital, Shanghai, China
| | - Jian Cai
- Department of Neurology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haifeng Jin
- Department of Neurology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Lin
- Department of Neurology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuhui Wang
- Department of Neurology, Punan Hospital, Shanghai, China
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Tanaka Y, Anami H, Kurihara H, Miyao S, Nakamoto H, Kubota Y, Kawamata T. Eagle syndrome with hidden stylocarotid syndrome examined using dynamic ultrasonography: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE21286. [PMID: 35854901 PMCID: PMC9245755 DOI: 10.3171/case21286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 11/06/2022]
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.
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Affiliation(s)
- Yukiko Tanaka
- Department of Neurosurgery and Stroke Center, TMG Asaka Medical Center, Saitama, Japan; and
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Hidenori Anami
- Department of Neurosurgery and Stroke Center, TMG Asaka Medical Center, Saitama, Japan; and
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Hiroyuki Kurihara
- Department of Neurosurgery and Stroke Center, TMG Asaka Medical Center, Saitama, Japan; and
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Satoru Miyao
- Department of Neurosurgery and Stroke Center, TMG Asaka Medical Center, Saitama, Japan; and
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Hidetoshi Nakamoto
- Department of Neurosurgery and Stroke Center, TMG Asaka Medical Center, Saitama, Japan; and
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yuichi Kubota
- Department of Neurosurgery and Stroke Center, TMG Asaka Medical Center, Saitama, Japan; and
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
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