A rare vascular complication of Eagle syndrome highlight by CTA with neck flexion

We report a case of a 53-year-old woman admitted to the emergency department with left hemiplegia, tinnitus and palpitations. A cerebral and cervical computed tomography angiography revealed an acute large ischemic stroke on the right Sylvian territory, which was related to a dissection of the right internal carotid. Moreover, a left internal carotid pseudo-aneurysm was observed. These two injuries were presumably imputable to a bilateral Eagle Syndrome. Indeed, the temporal styloid processes were measured at 31mm on both sides. To support our hypothesis of a stylocarotid impingement, a cervical CTA with hyperflexion (45°) of the neck was performed. It clearly revealed the bilateral impingement between the styloid processes and internal carotids. It seems important to know that Eagle syndrome may lead to disabling diseases or even death as well as an ischemic stroke. The vascular impingement with bilateral vascular injuries was never described. To our knowledge, our “neck flexion cervical CTA” to reveal the stylocarotid impingement has never been described before. This approach could lead to a new investigation technique, to better identify this underestimated pathology in the medical doctors community.