Bilateral Internal Carotid Artery Spasms Triggered by Elongated Styloid Processes: A Case Report

Elongated styloid processes that interact with the internal carotid arteries (ICAs) have been documented to lead to carotid artery stenosis, occlusion, or dissection, resulting in transient ischemic attack (TIA) or cerebral infarction. This study reports a unique case of bilateral ICA vasospasms triggered by elongated styloid processes and neck movements during physical activity, highlighting a potential vasospastic origin. A 52-year-old man experienced TIAs with visual disturbances while playing golf. Diagnostic imaging, including magnetic resonance angiography (MRA) and dynamic cerebral angiography, was performed to evaluate carotid artery involvement. MRA was used to assess ICA stenosis, while dynamic cerebral angiography was conducted to observe changes in the ICA during neck rotation. Imaging revealed bilateral ICA stenosis and an elongated styloid process. The resolution of the ICA stenosis on follow-up MRA suggested a potential vasospastic origin. Dynamic assessment using cerebral angiography showed narrowing of the right ICA during neck rotation. The vasospasm was likely induced by neck movement during golf.