Mechanical stress from the hyoid bone as a potential etiology of bony-related ischemic stroke secondary to carotid artery dissection: A case report and systematic review

Ischemic strokes resulting from internal carotid artery (ICA) dissection are typically associated with trauma, connective tissue disorders, or spontaneous causes. However, rare mechanical factors—including well-documented compression by the styloid process and, more exceptionally, by the hyoid bone—have been identified as potential triggers of such injuries. The close proximity or elongation of the hyoid bone relative to the ICA may exert pressure on or cause injury to the arterial wall, leading to hemodynamic or embolic ischemia in the anterior cerebral circulation, or to a transient ischemic attack (TIA). Carotid dissection may also occur as a result of repeated or sudden microtrauma. We report the case of a 46-year-old woman with no significant medical history, admitted 2 hours after the onset of ischemic stroke symptoms, which included left-sided heaviness and facial paralysis. The remainder of the clinical examination was unremarkable. Radiological investigations revealed an acute right sylvian ischemic infarction with abrupt occlusion of the ipsilateral middle cerebral artery on CT angiography. Imaging of the supra-aortic trunks demonstrated a dissection of the right ICA in direct contact with the posterior horn of the hyoid bone.