Recurrence of internal carotid artery dissection associated with elongated styloid process: A case report

Abstract

Background: An elongated styloid process is known to cause ischemic stroke. Previous reports claim that internal carotid artery (ICA) dissection due to the elongated styloid process has good outcomes when treated conservatively; however, long-term follow-up has not been attempted and recurrence in the later period has not been reported so far. We report a case of recurrence of symptoms over a decade after the initial onset. Case Description: A 59-year-old man experienced a transient ischemic attack (TIA) 10 years ago. Six years ago, he experienced hemispheric TIA, and magnetic resonance angiography revealed a diminished signal of the left ICA; however, no further examination was performed. Four years ago, he experienced another transient amaurosis attack and was treated with antiplatelet therapy because no embolic source was detected using ultrasonography examination, and he was diagnosed with idiopathic ICA dissection. Recently, he experienced a third amaurosis fugax attack. Digital subtraction angiography and cone-beam computed tomography demonstrated left cervical ICA dissection due to elongated styloid process. He underwent surgical resection of the left styloid process and cervical stent placement. He had no ischemic attacks postoperatively. Conclusion: The elongated styloid process may cause recurrent ischemic attacks over a decade due to ICA dissection.

Prevalence and characterization of the elongated styloid process in a population of southern Brazil

“…The point that when the involvement occurs in the internal carotid artery the patient can report a headache that extends from the ophthalmic region to the occipital, and can often be confused with a headache, which ends up inducing underdiagnosis (CAVALCANTE et al, 2017). Still, other studies report that Carotid Artery Syndrome may be associated with the occurrence of transient cerebral ischemic events (MILLÁN et al, 2019;RAFARE;CHAGAS, 2019;SHAYGANFAR et al, 2018;YOKOYA et al, 2021).…”

“…There are also reports in the literature of the occurrence of reversible transient ischemic attacks, with the presence of ophthalmic symptoms and episodes of presyncope due to compression of the carotid artery, as well as decreased blood flow in the middle cerebral artery caused by the elongation of the styloid process (JALISI; JAMAL; GRILLONE; 2017; MAHMOUD; ASHOUR; 2020; SAMPAIO et al, 2021;YOKOYA et al, 2021). Borges et al (2021) state that even in the absence of symptomatology reported by the patient, it is also important to diagnose cases in which stretching of the styloid process is observed, since in the future these individuals have greater chances of presenting them.…”