Reversible Left Hemispheric Ischemia Secondary to Carotid Compression in Eagle Syndrome: Surgical and CT Angiographic Correlation

SUMMARY: Symptoms of ipsilateral carotid artery compression secondary to an elongated styloid process or calcified stylohyoid ligament may be seen in Eagle syndrome. The patient will typically experience cervicofacial pain due to stimulation of the arterial nervous plexus. In addition, symptoms directly attributable to compression of the carotid artery may be seen, including visual symptoms and syncope. We report here the case of a patient who developed symptoms consistent with left hemispheric ischemia within 15 seconds of turning his head to the left. These symptoms were completely reversible on returning the head to the neutral position. No long-term sequelae were detected clinically or radiographically. In 1937, Eagle described a pair of cases in which an elongatedstyloid process was associatedwith facial pain.1 Since then, it has been recognized that uncommonly face andneck painmay be associated with an elongated styloid process. More uncom-monly, symptoms such as dysphagia, tinnitus, and otalgiamay occur. Eagle syndrome is now thought to be due to 2 different subtypes,2 the classic form resulting from cranial nerve im-pingement and the second type from impingement of the ca