A Case of Eagle's Syndrome with Acute Cerebral Infarction Caused by the Dissection of the Extracranial Internal Carotid Artery

Abstract

Eagle's syndrome presents with a series of symptoms caused by an elongated styloid process and/or the ossification of part of the entire stylohyoid ligament. Symptoms of the classic type are caused by factors such as irritation and compression of the lower cranial nerve, sore throat and dys-phagia, facial pain, and neck pain. The other rare type is caused by compression or dissection of the carotid artery, causing a transient ischemic attack or stroke. This report describes a case of Eagle's syndrome with cerebral infarction caused by internal carotid artery (ICA) dissection, treated with en-dovascular revascularization of the ICA and surgical resection of the styloid process. A 51-year-old woman presented with sudden onset of right hemiparesis and aphasia. Magnetic resonance imaging revealed left ICA occlusion. Endovascular recanalization therapy for the ICA occlusion was initiated, and recanalization with thrombolysis of the cerebral infarction (TICI) grade IIb was achieved. Carotid artery dissection with intraluminal thrombus was observed at the extracranial portion. Computed to-mographic angiography on day 6 revealed the dissected ICA compressed by the elongated styloid process. On day 24, the elongated styloid process was resected extraorally, and successful decompres-sion of the ICA was achieved. ICA dissection caused by an elongated styloid process has been reported frequently. Eagle's syndrome is rare but is one of the important diseases to consider in the differential diagnosis of extracranial carotid artery dissection.