Eagle's syndrome: Viewing a rare disorder from a new perspective
Shah K, and Miller DJ. Eagle's syndrome: Viewing a rare disorder from a new perspective. Neurology 2017; 88(16 Suppl).
Objective: To highlight a novel approach to evaluate a patient with an uncommon cerebrovascular condition via a versatile, safe, and cost-efficient option through a 3-Dimensional (3D) model. Background: In 1948, Dr. Eagle outlined a subset of cases where patients presented with a characteristic constellation of findings: carotidynia and headache. These symptoms were attributed to an elongated styloid process affecting the ipsilateral carotid artery, termed the styloid-carotid artery syndrome. Design/Methods: We report a 63-year-old gentleman who presented with transient episodes of left-hand weakness and right-eye vision loss following a lengthy airplane trip that was found to be secondary to the styloid-carotid artery syndrome. He reported that he had slept awkwardly for the duration of the flight with his head resting on his right shoulder. Results: The patient's initial CT of the head and CTA of the head and neck revealed a right internal carotid artery (ICA) occlusion and suspected dissection. Subsequent MRI only revealed a punctate acute infarct in the right frontal white matter, but high suspicion remained for a significant abnormality of the R ICA. CTA was repeated after 6 weeks, demonstrating a recanalized vessel and revealing an elongated styloid process in the vicinity of the previous occlusion. Conventional angiography with reproduction of the head tilt that caused the initial event was considered; however, given the risk of instigating another event, a 3D model of the CTA data was created utilizing a 3D printer. The dynamic nature of the model with an artificial spine with flexible joints permitted free manipulation of the patient's unique anatomy without posing any risk to his condition. Conclusions: This case not only exhibits an uncommon etiology for stroke, but also introduces an innovative method to visualize complex neuroanatomy. Given the relatively low cost and harmless creation of the model, this option may prove beneficial in other similar cases.