Internal carotid artery trauma due to elongated styloid process – a review of case reports
Keywords:Carotid artery dissection, carotid artery compression, Eagle syndrome, Stylocarotid syndrome, elongated styloid process, internal carotid artery, stroke
INTRODUCTION: Stylocarotid syndrome is caused by the conflict between the styloid process and the vascular structures leading to carotid artery dissection (CAD) or compression. Being headache the most common initial symptom in patients with spontaneous CAD, eagle syndrome could be one explanation for some so-called spontaneous dissections since this symptom is also common in this syndrome.
METHODS: Afrer analyzing the reported cases on Pubmed and Embase databases we divided the cases in compression and CAD groups ending up with completely different groups in terms of clinical presentation, management and follow-up.
RESULTS: While management of compression group seems quite straightforward, the same is not true when CAD is present. Whether delayed styloidectomy after medical management plays a role in CAD, as it does for the compression group, is something to investigate.
Eagle WW. Elongated styloid process: Report of two cases. Arch Otolaryngol. 1937;25:584–86
Sidawy, A. N., Perler, B. A., & Rutherford, R. B. (2019). Rutherford's vascular surgery and endovascular therapy Volume 2; Chapter 96, 1269-1276
Raina D, Gothi R, Rajan S. Eagle syndrome. Indian J Radiol Imaging 2009;19:107-8
Rechtweg JS, Wax MK. Eagle's syndrome: A review. Am J Otolaryngol. 1998;19:316–21
AlAbdulwahed R, O'Flynn P. The Eagle Has Landed: an unusual case of Eagle's syndrome. J Surg Case Rep 2021;2021(12):rjab530
Zuber M, Meder JF, Mas JL. Carotid artery dissection due to elongated styloid process. Neurology 1999;53:1886-7
Soo-O-yan Y, Chan YL, Wong KS. Carotid artery dissection after prolonged head tilting while holding a newborn baby to sleep. Neurology 2004;62:1647–8
Faivre A, Abdelfettah Z, Rodriguez S. Neurological picture. bilateral internal carotid artery dissection due to elongated styloid processes and shaking dancing. J Neurol Neurosurg Psychiatry 2009;80:1154-5
Razak A, Short JL, Hussain SI. Carotid artery dissection due to elongated styloid process: a self-stabbing phenomenon. J Neuroimaging 2014;24:298– 301
Todo T, Alexander M, Stokol C, Lyden P, Braunstein G, Gewertz B. Eagle syndrome revisited: cerebrovascular complications. Ann Vasc Surg. 2012 Jul;26:729.e1-5.
Ogura T, Mineharu Y, Todo K, Kohara N, Sakai N. Carotid Artery Dissection Caused by an Elongated Styloid Process: Three Case Reports and Review of the Literature. NMC Case Rep J. 2014 Dec 6;2:21-25.
Sveinsson O, Kostulas N, Herrman L. Internal carotid dissection caused by an elongated styloid process (Eagle syndrome). BMJ Case Rep 2013; bcr2013009878
Yamamoto S, Todo K, Kawamoto M, Kohara N. Carotid artery dissection associated with an elongated styloid process. Intern Med. 2013;52:1005-6.
Ohara N, Sakaguchi M, Okazaki S, Nagano K, Kitagawa K. Internal carotid artery dissection caused by an elongated styloid process: usefulness of transoral ultrasonography. J Stroke Cerebrovasc Dis. 2012 Nov;21:918.e7-8.
Jo H, Choi EH, Song J. Carotid artery dissection caused by Eagle syndrome precision and future. Medicine 2017;1:173–6
Subedi R, Dean R, Baronos S, Dhamoon A. Carotid artery dissection: a rare complication of Eagle syndrome. BMJ Case Rep. 2017;13:bcr2016218184.
Hebant B, Guegan-Massardier E, Macaigne V, Triquenot-Bagan A. Ischemic stroke due to internal carotid artery dissection associated with an elongated styloid process (Eagle syndrome). J Neurol Sci. 2017 Jan 15;372:466-7
Smoot TW, Taha A, Tarlov N, Riebe B. Eagle syndrome: A case report of stylocarotid syndrome with internal carotid artery dissection. Interv Neuroradiol. 2017;23:433-6
Jelodar S, Ghadirian H, Ketabchi M, Ahmadi Karvigh S, Alimohamadi M. Bilateral Ischemic Stroke Due to Carotid Artery Compression by Abnormally Elongated Styloid Process at Both Sides: A Case Report. J Stroke Cerebrovasc Dis 2018;27:e89-e91
Zammit M, Chircop C, Attard V, D'Anastasi M. Eagle's syndrome: a piercing matter. BMJ Case Rep 2018;28;11:e226611
Torikoshi S, Yamao Y, Ogino E, Taki W, Sunohara T, Nishimura M. A Staged Therapy for Internal Carotid Artery Dissection Caused by Vascular Eagle Syndrome. World Neurosurg. 2019;129:133-9
Galletta K, Granata F, Longo M, Alafaci C, De Ponte FS, Squillaci D, De Caro J, Grillo F, Benedetto F, Musolino R, Grasso G, Siniscalchi EN. An unusual internal carotid artery compression as a possible cause of Eagle syndrome - A novel hypothesis and an innovative surgical technique. Surg Neurol Int 2019;10;10:174
Baldino G, Di Girolamo C, De Blasis G, Gori A. Eagle Syndrome and Internal Carotid Artery Dissection: Description of Five Cases Treated in Two Italian Institutions and Review of the Literature. Ann Vasc Surg. 2020;67:565.e17-24
Takagi M, Nishimura A, Ikenouchi H, Nishimura A, Yamaguchi E, Koge J, Saito K et al. Bilateral carotid artery dissection due to Eagle syndrome in a patient with vascular Ehlers-Danlos syndrome: a case report. BMC Neurol 2020;20:285
Duarte-Celada WR, Jin D, Neves G, Windisch T. Bilateral carotid dissection due to Eagle syndrome in a young female. eNeurologicalSci. 2021;16;24:100353
Horio Y, Fukuda K, Miki K, Hirao N, Iwaasa M, Abe H, Inoue T. Dynamic assessment of internal carotid artery and elongated styloid process in a case of bilateral carotid artery dissection. Surg Neurol Int 2020;27;11:163
Brassart N, Deforche M, Goutte A, Wery D. A rare vascular complication of Eagle syndrome highlight by CTA with neck flexion. Radiol Case Rep 2020;29;15:1408-12
Mattioli P, Baldino G, Castaldi A. A peculiar case of internal carotid dissection: "do not forget Eagle's syndrome!". Neurol Sci 2021;42:2527–9
Xhaxho S, Vyshka G, Kruja J. Eagle syndrome presenting as a neurological emergency: a case report. Surg Neurol Int 2021;12:257
Muthusami P, Kesavadas C, Sylaja PN, Thomas B, Harsha KJ, Kapilamoorthy TR. Implicating the long styloid process in cervical carotid artery dissection. Neuroradiology 2013;55:861-7
Selvadurai S, Williamson A, Virk JS, Clarke P. Eagle syndrome and carotid artery dissection: a rare skull base cause of stroke. BMJ Case Rep 2022;9;15:e247954
Usseglio J, Montoro FM, Martin S, Lerat J, Laloze J, Taibi A, Brie J. Accident ischémique transitoire, une manifestation rare du syndrome d’Eagle [Transcient ischemic attack, a rare manifestation of Eagle syndrome] Rev Stomatol Chir Maxillofac Chir Orale 2016;117:421-4
David J, Lieb M, Rahimi SA. Stylocarotid artery syndrome. J Vasc Surg 2014;60:1661-3
Farhat HI, Elhammady MS, Ziayee H, Aziz-Sultan MA, Heros RC. Eagle syndrome as a cause of transient ischemic attacks. J Neurosurg 2009;110:90-3
Song JH, Ahn SK, Cho CB. Elongated styloid process as a cause of transient ischemic attacks. JAMA Neurol 2013;70:1072-3
Chuang WC, Short JH, McKinney AM, Anker L, Knoll B, McKinney ZJ. Reversible left hemispheric ischemia secondary to carotid compression in Eagle syndrome: surgical and CT angiographic correlation. AJNR Am J Neuroradiol 2007;28:143-5
Aydin E, Quliyev H, Cinar C, Bozkaya H, Oran I. Eagle Syndrome Presenting with Neurological Symptoms. Turk Neurosurg 2018;28:219-25
Menon R, Kerry S, Norris JW, Markus HS. Treatment of cervical artery dissection: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2008;79:1122-7
Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection. Cochrane Database Syst Rev 2008;4:1-30
Pham MH, Rahme RJ, Arnaout O, Hurley MC, Bernstein RA, Batjer HH, Bendok BR. Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature. Neurosurgery. 2011;68:856-66
Gompertz P, Price C, Kerry S, Norris J, Markus HS; CADISS Investigators. Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology 2012;79:686-9
Cervical Artery Dissection in Stroke Study Trial Investigators. Antiplatelet therapy vs. anticoagulation in cervical artery dissection: rationale and design of the Cervical Artery Dissection in Stroke Study (CADISS). Int J Stroke 2007;2:292–6