A Case of a Very Elongated Styloid Process

Liu, Yali; Yang, Huaian; Cui, Xiangguo

doi:10.1177/1179550617728899

Cited by 3 publications

(2 citation statements)

References 20 publications

(20 reference statements)

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“…Styloidectomy is the gold standard treatment for Eagle syndrome. Although a transcervical approach has been used, [14][15][16][17][18] a transoral approach is usually chosen. Because it is difficult to expose the deeper part of the styloid process, the transcervical approach is the more suitable option for stylocarotid syndrome.…”

Section: Discussionmentioning

confidence: 99%

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

Tanaka

Anami

Kurihara

et al. 2021

Journal of Neurosurgery: Case Lessons

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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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Section: Discussionmentioning

confidence: 99%

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

Tanaka

Anami

Kurihara

et al. 2021

Journal of Neurosurgery: Case Lessons

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“… 1 Although the prevalence of ESP ranges from 4.0% to 7.3%, 1 symptoms are rare, presenting in only approximately 4.0% of individuals with an ESP. 2 Unlike the typical symptoms of ES, SAS may not cause pharyngeal discomfort, the sensation of a foreign body in the throat, dysphagia, or facial pain. This absence of characteristic symptoms coupled with 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.…”

Section: Introductionmentioning

confidence: 99%

Ischemic stroke due to stylocarotid artery syndrome: a case report and review

Liu,

Li,

Zheng

et al. 2024

J Int Med Res

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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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Neurological phenotypes and treatment outcomes in Eagle syndrome: systematic review and meta-analysis

Hassani,

Grønlund,

Albrechtsen

et al. 2024

PeerJ

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Background Eagle syndrome is caused by an elongated styloid process affecting carotid arteries and cranial nerves. Pain, dysphagia, tinnitus, paresthesia (classic subtype), and neurovascular events (vascular subtype) may be triggered by head movements or arise spontaneously. However, Eagle syndrome remains underappreciated in the neurological community. We aimed to determine the most common neurological and non-neurological clinical presentations in patients with Eagle syndrome and to assess the clinical outcome post-surgical resection in comparison to non-surgical therapies. Methodology We conducted a systematic review of patient-level data on adults with Eagle syndrome, following PRISMA guidelines. We extracted data on demographics, presenting symptoms, neurological deficits, radiological findings, and treatments, including outcomes and complications, from studies in multiple indexing databases published between 2000 and 2023. The study protocol is registered with PROSPERO. Results In total, 285 studies met inclusion criteria, including 497 patients with Eagle syndrome (mean age 47.3 years; 49.8% female). Classical Eagle (370 patients, 74.5%) was more frequent than vascular Eagle syndrome (117 patients, 23.5%, p < 0.0001). Six patients (1.2%) presented with both variants and the subvariant for four patients (0.8%) was unknown. There was a male preponderance (70.1% male) in the vascular subtype. A history of tonsillectomy was more frequent in classic (48/153 cases) than in vascular (2/33 cases) Eagle syndrome (Odds Ratio 5.2, 95% CI [1.2–22.4]; p = 0.028). By contrast, cervical movements as trigger factors were more prevalent in vascular (12/33 cases) than in classic (7/153 cases) Eagle syndrome (Odds Ratio 7.95, 95% CI [2.9–21.7]; p = 0.0001). Headache and Horner syndrome were more frequent in vascular Eagle syndrome and dysphagia and neck pain more prominent in classic Eagle syndrome (all p < 0.01). Surgically treated patients achieved overall better outcomes than medically treated ones: Eighty-one (65.9%) of 123 medically treated patients experienced improvement or complete resolution, while the same applied to 313 (97.8%) of 320 surgical patients (Odds Ratio 1.49, 95% CI [1.1–2.0]; p = 0.016). Conclusions Eagle syndrome is underdiagnosed with potentially serious neurovascular complications, including ischemic stroke. Surgical treatment achieves better outcomes than conservative management. Although traditionally the domain of otorhinolaryngologist, neurologist should include this syndrome in differential diagnostic considerations because of the varied neurological presentations that are amenable to effective treatment.

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A Case of a Very Elongated Styloid Process

Cited by 3 publications

References 20 publications

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

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

Ischemic stroke due to stylocarotid artery syndrome: a case report and review

Neurological phenotypes and treatment outcomes in Eagle syndrome: systematic review and meta-analysis

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