Carotid artery dissection: a rare complication of Eagle syndrome

Background The elongation of the styloid process is historically associated with two variants of the Eagle syndrome. The classic one, mainly characterized by pain and dysphagia, and the carotid variant characterized by pain and sometimes by cerebral ischemia. We observed a further variant characterized by a styloid elongation coursing adjacent to the transverse process of C1, causing significant compression of the internal jugular vein. Methods We revised all the cases of Eagle syndrome, including the jugular variant, admitted in our Hospital in the last six years. We compared symptomatology, associated comorbidities and imaging. Data were statistically analyzed. Results Overall 23 patients were admitted to the Hospital for symptomatic elongation of the styloid process, 11 male and 12 females. The jugular variant of the Eagle syndrome is clinically delineated by significant differences, as compared to the classic variant and carotid variants. Headache was the more prominent symptom (p<.009) as well as a documented peri-mesencephalic hemorrhage was the more significant comorbidity (p<.0003). The group classic-carotid variant was characterized by ipsilateral pain respect to the jugular variant (p<.0003). CT angiography with venous phase extended to the neck veins and imaging reconstruction is highly recommended as imaging technique, complemented by color-Doppler ultrasound. Conclusions The elongation of the styloid process may have different paths which creates compression on the surrounding anatomical structures. There may be a possible association of jugular impingement by an elongated styloid process with symptoms.

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Section: Discussionmentioning

confidence: 99%

The Eagle Jugular Syndrome

Zamboni

Scerrati

Menegatti

et al. 2019

Preprint

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“…From our review four patients underwent initial CAS,3 9 16 26 with one patient requiring further management due to stroke recurrence 16. However, two cases reported use of CAS as additional treatment following recurrent ischaemic events, with no other episodes reported 8 24…”

Section: Discussionmentioning

confidence: 90%

“…From the literature review, eight patients underwent solely medical therapy initially,8 9 16 21–25 with three patients requiring surgical or endovascular interventions 8 9 26…”

Section: Discussionmentioning

confidence: 99%

Eagle’s syndrome: a piercing matter

Zammit¹,

Chircop

Attard

et al. 2018

BMJ Case Rep

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We present an unusual case of Eagle’s syndrome with bilateral internal carotid artery dissection in a 45-year-old man. Initial symptomatology included ipsilateral headaches and facial sensory symptoms. A right horner’s syndrome was present on clinical examination. Radiological imaging revealed an old infarct, with bilateral carotid dissections and bilateral elongated styloid processes consistent with Eagle’s syndrome. Despite initiation of secondary prevention with antiplatelet therapy, he had two further ischaemic events. The case highlights the symptomatology and complications of Eagle’s syndrome, with its management discussed through a review of similar case reports.

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“…Cases of Horner's syndrome are usually explained with the compression of the nerve fibers of sympathetic nervous system [1]. Apart from the classic pattern, also a 'carotid' variant has been described, where peculiar symptoms such as arterial dissection, obstruction, transient ischemic attack and cerebral ischemia were found associated [8][9][10][11]. It is more difficult to explain cases of Eagle syndrome associated with migraine and headache, which could be more consistently related to the external compression of internal jugular vein (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] The latter is thought a consequence of an elongated styloid process impinging upon the carotid artery and associated nerve endings, causing pain and sometimes facilitating vascular complications and cerebral ischemia. [8][9][10][11] In both syndromes, the length of the styloid process was thought to be the major causal factor. In addition, it has also been observed a variant of the Eagle syndrome, where an elongated styloid process is coursing adjacent to the transverse process of C1.…”

Section: Introductionmentioning

confidence: 99%

The Eagle Jugular Syndrome

Zamboni

Scerrati

Menegatti

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: The elongation of the styloid process is historically associated with two variants of the Eagle syndrome. The classic one, mainly characterized by pain and dysphagia, and the carotid variant characterized by pain and sometimes by cerebral ischemia. We observed a further variant characterized by a styloid elongation coursing adjacent to the transverse process of C1, causing significant compression of the internal jugular vein. Methods : We reviewed all the cases of Eagle syndrome, including the jugular variant, admitted in our Hospital in the last six years. We compared symptomatology, associated comorbidities and imaging. Data were statistically analyzed. Results : Overall 23 patients were admitted to the Hospital for symptomatic elongation of the styloid process, 11 male and 12 females. The jugular variant of the Eagle syndrome is clinically delineated by significant differences, as compared to the classic variant and carotid variants. Headache was the more prominent symptom (p<.009) as well as a documented peri-mesencephalic hemorrhage was the more significant comorbidity (p<.0003). The group classic-carotid variant was characterized by ipsilateral pain respect to the jugular variant (p<.0003). CT angiography with venous phase extended to the neck veins and imaging reconstruction is highly recommended as imaging technique, complemented by color-Doppler ultrasound. Conclusions : The elongation of the styloid process may have different paths which creates compression on the surrounding anatomical structures. There may be a possible association of jugular impingement by an elongated styloid process with symptoms.

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Carotid artery dissection: a rare complication of Eagle syndrome

Cited by 25 publications

References 18 publications

The Eagle Jugular Syndrome

The Eagle Jugular Syndrome

Eagle’s syndrome: a piercing matter

The Eagle Jugular Syndrome

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