scholarly journals Dynamic assessment of internal carotid artery and elongated styloid process in a case of bilateral carotid artery dissection

2020 ◽  
Vol 11 ◽  
pp. 163
Author(s):  
Yoshinobu Horio ◽  
Kenji Fukuda ◽  
Koichi Miki ◽  
Noriko Hirao ◽  
Mitsutoshi Iwaasa ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Dynamic Assessment ◽  
Head Rotation ◽  
Styloid Process ◽  
Artery Dissection ◽  
Elongated Styloid Process ◽  
Bilateral Carotid ◽  
Eagle Syndrome

Background: Vascular Eagle syndrome is that an elongated styloid process causes ischemic stroke due to internal carotid artery (ICA) dissection. Dynamic assessment using radiological imaging has not been well investigated. We assessed the change in the relative positional relationship between the elongated styloid process and the ICA using a cone-beam computed tomography (CBCT). Case Description: A 46-year-old female presenting with disturbance of consciousness, right hemiparesis, and aphasia was admitted to our hospital. Initial CT analysis showed a bilateral elongated styloid process. Magnetic resonance angiography (MRA) showed occlusion of the left ICA and a near occlusion of the right ICA. MRA also revealed the intimal flap and intramural hematoma in the bilateral ICA. Digital subtraction angiography showed bilateral ICA occlusion and carotid artery stenting was performed subsequently. After that, we visualized the movement of carotid stent with CBCT fusion methods. The stent moved forward and backward at the attachment point of the styloid process during head rotation, and there was a possibility that mechanical stress was emphasized at this point. Styloidectomy was performed after her rehabilitation. The patient did not experience a recurrence of stroke. Conclusion: We showed that repeated attachment of the styloid process and ICA may trigger an ICA dissection during head rotation. This finding would be helpful for understanding the causes of vascular Eagle syndrome.

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

2021 ◽  
Vol 12 ◽  
pp. 473
Author(s):  
Shigeomi Yokoya ◽  
Hidesato Takezawa ◽  
Hideki Oka ◽  
Akihiko Hino
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Styloid Process ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Elongated Styloid Process ◽  
Initial Onset ◽  
Long Term Follow Up ◽  
Ischemic Attack

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.

Compression of the cervical internal carotid artery by the stylopharyngeus muscle: an anatomical study with potential clinical significance

2010 ◽  
Vol 113 (4) ◽  
pp. 881-884 ◽  
Author(s):  
R. Shane Tubbs ◽  
Marios Loukas ◽  
Joshua Dixon ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Anatomical Study ◽  
Styloid Process ◽  
Elongated Styloid Process ◽  
Eagle Syndrome ◽  
Definition Of ◽  
Ica Stenosis ◽  
The Relationship

Object Occasionally, the internal carotid artery (ICA) may be symptomatically compressed in the neck by an elongated styloid process. The authors are unaware, however, of any study to date in which the aim was to describe the compression of this part of the ICA by surrounding muscles extending from the styloid process. Methods In 20 adult cadavers (40 sides), dissection of the cervical ICA was performed, with special attention given to the relationship between this artery and the stylopharyngeus muscle. In addition, rotation of the head was performed while observing for any compression of the ICA by this muscle. Last, the segment of the ICA immediately adjacent to the stylopharyngeus was excised and evaluated for signs of gross compression. Results Five sides (12.5%) were found to have an ICA that was grossly compressed by the neighboring stylopharyngeus muscle, and this was confirmed on excised ICA specimens. Moreover, such compression was increased with ipsilateral rotation of the head. Effacement of the lumen of the ICA by the stylopharyngeus ranged from approximately 30 to 50%. Such compression was increased by approximately 25% with ipsilateral rotation of the head. Conclusions To the authors' knowledge, compression of the cervical ICA by the stylopharyngeus muscle has not been previously described. Such a relationship should be appreciated by the clinician who treats patients with symptoms of ICA stenosis or occlusion as a potential extracranial site of compression. Based on this study, a subset of patients with occlusion of the cervical ICA but without elongation of the styloid process should be included within the definition of Eagle syndrome.

scholarly journals Eagle syndrome: A case report of stylocarotid syndrome with internal carotid artery dissection

2017 ◽  
Vol 23 (4) ◽  
pp. 433-436 ◽  
Author(s):  
Travis W Smoot ◽  
Ammar Taha ◽  
Nicholas Tarlov ◽  
Blake Riebe
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Rare Complication ◽  
Styloid Process ◽  
Carotid Artery Dissection ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
Eagle Syndrome ◽  
Stylohyoid Ligament

Eagle syndrome is defined by an elongated styloid process or a calcified stylohyoid ligament that impinges on surrounding structures and causes a variety of symptoms. Classically, Eagle syndrome presents as neck, throat, or ear pain. The vascular variant, stylocarotid syndrome, can present as headache, transient ischemic attack, or stroke. Carotid artery dissection is a rare complication of stylocarotid syndrome. We report a case of stylocarotid syndrome in a 60-year-old man who presented with a right internal carotid artery (ICA) dissection and focal neurological deficits. Computed tomography with three-dimensional reformatting was used in the evaluation of his pathology. His dissecting right ICA was stented with subsequent symptom resolution. Improved recognition of the relationship between an elongated styloid or calcified stylohyoid ligament and symptomatology may lead to optimal etiology recognition and directed treatment.

scholarly journals O28 Can styloid process and internal carotid artery anatomy be used to predict carotid artery dissection?

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
L Cruddas ◽  
M Joffe ◽  
D Baker
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Styloid Process ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Radiological Measurements ◽  
Stroke In The Young ◽  
And Gender ◽  
Process Length

Abstract Introduction Carotid artery dissection is a common cause of stroke in the young. It has been related to the association of the carotid artery with fixed neighbouring anatomical structures. This study assesses the association between styloid process length, internal carotid artery position and cervical carotid artery dissection (CCAD). This information would provide potential predicative radiological measurements, which could prevent delays in CCAD diagnosis. Method Retrospective data was collected from two central London hospitals over five years. CCAD cases were identified from individuals who underwent computer topography angiography (CTA) of the neck for suspected CCAD. The following data was collected: evidence of CCAD; bilateral styloid process length and presence of styloid-hyoid ligament calcification; bilateral styloid process-internal carotid distance; calcification of carotid arteries and whether their position was aberrant. Cases were dissection-side, age and gender matched with two non-dissection controls. Result Three hundred and fifty-five individuals were identified. Fifty individuals had CCAD, of which 4 had bilateral dissection. In individuals with CCAD, average styloid process length was 27.5 mm and styloid process-internal carotid distance was 5.14 mm. There was no significant association between styloid process length or styloid process-internal carotid distance, and CCAD when compared with matched controls. Internal carotid artery aberrancy was significant for non-dissection. Conclusion In this study, there was no association between styloid process length and styloid process-internal carotid distance with CCAD. These measurements can not be used to predict the possibility of a CCAD following trauma. Take-home Message Anatomy of the styloid process and calcification of the styloid-hyoid ligament are highly variable and many independent factors may contribute to the risk of cervical carotid artery dissection. Radiological measurements of the styloid process alone cannot be used to predict risk and likelihood of cervical carotid artery dissection.

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