Eagle syndrome: An updated review

Abstract

Background: This work aims to review the current literature and our experience on vascular Eagle syndrome (ES) that can present misleading clinical presentations and better understand the possible therapeutic strategies. Methods: We reviewed the existing literature on PubMed from January 1, 2017, to December 31, 2022, including the sequential keywords “vascular AND Eagle syndrome,” “vascular AND styloid syndrome,” “vascular AND elongated styloid process,” “vascular AND stylocarotid syndrome,” and “Eagle syndrome AND carotid artery dissection.” Results: 38 vascular ES cases, including our experience, were analyzed. The most frequent clinical onset was hemiparesis (n 21, 57%), but other regular clinical presentations were aphasia, loss of consciousness, amaurosis, headache, or a combination of the latter. Massive oral bleeding was reported only once in the literature before our case. Twelve patients were treated with only antiplatelet therapy, either single or double. Nine patients were treated with anticoagulation therapy only. In 14 patients, a carotid artery stent was used, associated with anticoagulation or antiplatelet therapy. In 17 cases, a styloid process (SP) resection was performed. Conclusion: ES has many clinical presentations, and carotid artery dissection resulting in oral bleeding seems rare. Literature results and our experience make us believe that when dealing with vascular ES, the best treatment strategy is endovascular internal carotid artery stenting with antiplatelet therapy, followed by surgical removal of the elongated SP to prevent stent fracture.

Eagle’s Syndrome: A Fortunate Discovery in a Symptomatic Patient

“…However, only 4% of these cases are symptomatic, and therefore, the true incidence of Eagle’s syndrome is about 0.16%, showing a three times higher prevalence in females compared to males. Patients are usually older than 30 years of age, and they usually have bilaterally elongated processes (although unilateral cases have also been described) [ 6 , 7 ].…”

“…This is why they are often falsely attributed to a wide variety of other pathologies. Differential diagnoses include migraine-type headaches, facial neuralgias or oral, dental, and hyoid bursitis, otitis, temporomandibular diseases, temporal arteritis, cervical arthritis, carotid artery dissection, glossopharyngeal neuralgia, head and neck tumors, cervical mass, faulty dental prostheses, esophageal diverticula, salivary gland disease, and trigeminal neuralgia [ 5 , 7 , 8 , 9 ]. Therefore, due to the commonality of these symptoms and the rarity of Eagle syndrome, our main insight from this case is the importance of physician awareness of the syndrome to ensure accurate diagnosis.…”