June 2023
An older man complaining of headache, preauricular pain, dysphagia to solids, cough, vertigo followed by left-sided facial deviation, and neck pain
Internal Carotid Artery Dissection Secondary to Eagle Syndrome Resulting in Multifocal Infarcts and Ultimately Brain Death
- Background:
- Eagle syndrome is characterized by symptomatic elongation of the styloid process.
- It may be unilateral or bilateral; however, it is more often bilateral.
- It can also occur due to calcification of the stylohyoid ligament.
- It is idiopathic in etiology; however, it may be associated with conditions causing heterotopic calcification or chronic renal failure.
- Clinical Presentation:
- It causes symptoms due to either compression of the vessels or compression of the nerves.
- Symptoms include syncope, visual symptoms, facial pain upon movement, dysphagia, foreign body sensation, pain on extending the tongue, change in voice, tinnitus, or otalgia.
- One known complication of Eagle syndrome is mechanical compression of the carotid artery or its branches resulting in dissection.
- Key Diagnostic Features:
- One key diagnostic feature is the target sign on CTA. The target sign signifies faint rim enhancement of the vessel wall, which is supplied by vasa vasorum, while the vascular lumen is thrombosed and does not show contrast opacification.
- On sagittal imaging, a sharp-slant interface is seen between the patent and thrombosed part of the vessel, representing the false lumen that has been thrombosed and has occluded the rest of the vessel lumen. An intimal flap may be seen.
- Presentation can be acute.
- Differential Diagnoses:
- Atherosclerosis
- Embolism
- Treatment:
- Staged therapy has proven to be beneficial in treating vascular Eagle syndrome. It includes:
- Stenting in the acute phase
- Surgical resection of the styloid process in the chronic phase
- Staged therapy has proven to be beneficial in treating vascular Eagle syndrome. It includes:
