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The authors describe a compelling case of transient ischemic attack with repeated short episodes. associated with elongation of the styloid process (synonymous with ossification of the sylohydoid ligament). The image-rendered single projection show the right common carotid and adjacent internal and external carotid arteries. There is elongation of the internal carotid artery with redundant tortuosity but no arterial stenosis is shown on this projection. The elongation and redundancy may reflect long-standing hypertension, a vascular risk factor.
This then is a case of TIAs without stenosis shown in the carotid arteries, or ischemic mimic, like focal seizures or migraine. In my experience as a neuroradiologist with more than 40 years experience in Ontario with imaging for stroke and TIA, the indicated management of such a TIA presentation would also include a possible cardiac source of thromboembolic including cardiac arrhythmia as well as coagulation profiles. Intracranial arteries also need investigation.
The diagnosis of Eagle's phenomenon of longer than usual styloid has always been dubious to explain carotid disease. The non-ossified stylohyoid ligament is also a solid rigid ligamentous structure. It is normal on both sides for everyone. There is a challenge for any report of so-called Eagle's Syndrome as to explain why a longer styloid, a bony structure connecting with stylohyoid ligament, is uniquely rigid when non-ossifed ligaments are also u...
Show MoreCompeting Interests: None declared.References
- Joel W. Howlett, Matthew Hearn, Cameron Bakala. Eagle syndrome causing severe stenosis of the internal carotid artery. CMAJ 2021;193:E1091-E1091.