Bony Stroke: Clinical Features, Management, and Outcomes in a Case Series of Seven Patients

Bony stroke is defined as a stroke caused by a conflict between the carotid or vertebral arteries and an osseous or fibrous structure. This conflict can be permanent or triggered by specific head positions. It represents an uncommon cause of stroke in young individuals. Diagnosis requires multimodal imaging with both static and dynamic vascular assessments. We report a retrospective case series of seven patients in whom a bony or structural anomaly was identified as the etiology of stroke after exclusion of other possible causes. The mean age was 50.5 years. Bony anomalies included vascular Eagle syndrome in five patients, with one case of bilateral internal carotid artery conflict with elongated styloid processes and two cases of carotid compression by the hyoid bone. Curative anticoagulation was prescribed in most patients, and surgical removal of the bony anomaly was performed in four cases. No stroke recurrence was observed in our series. One patient died from septic shock. This study highlights the importance of investigating structural abnormalities in young patients with stroke, particularly in cases of recurrence in the same arterial territory, since appropriate treatment can eliminate the risk of recurrence.