Internal carotid artery dissection caused by elongated styloid process

Area of Science:

• Neurology
• Neurosurgery
• Vascular Surgery

Background:

• Internal carotid artery dissection can lead to ischemic stroke, presenting with neurological deficits such as hemiplegia and aphasia.
• An elongated styloid process is a rare anatomical variant that can cause Eagle syndrome or, in this case, potentially compress or injure the internal carotid artery.

Observation:

• A 69-year-old male presented with stroke symptoms, diagnosed via MRI and 3D CT as cerebral infarction secondary to left internal carotid artery dissection.
• Pre-procedural imaging revealed the left elongated styloid process was in close proximity (2 mm) to the dissected left internal carotid artery.

Findings:

• The patient underwent successful left internal carotid artery stenting 16 days after symptom onset.
• Surgical resection of the left elongated styloid process was performed to mitigate the risk of further carotid artery injury.

Implications:

• Resection of an elongated styloid process can be an effective preventative measure against recurrent carotid artery dissection in select cases.
• This case highlights the importance of identifying and addressing anatomical abnormalities contributing to cerebrovascular events.