Multiple Strokes Associated With Elongation of the Hyoid Bone

Hyoid bone elongation is an uncommon cause of stroke. Here, we report a case of hyoid bone elongation causing localized trauma to the internal carotid artery, resulting in multiple strokes. A 32-year-old woman presented with unilateral weakness and history of a recent stroke. Imaging revealed the greater horn of the hyoid bone extending between the external and internal carotid with associated thrombus at the carotid bifurcation and acute stroke. Carotid ultrasound demonstrated movement of the hyoid bone in and out of the space between the external carotid artery and internal carotid artery with neck rotation. Treatment involved anticoagulation and partial hyoid bone resection. After resection, the stroke symptoms had not recurred in the patient. Hyoid bone-related carotid injury is an infrequent etiology of stroke, with no established treatment guidelines. Partial hyoid bone resection and antithrombotic therapy are likely a reasonably safe and effective treatment.