Eagle syndrome. A rare etiology of internal carotid artery dissection revealed by dynamic CT angiography

Arterial dissection accounts for 2% of all ischemic strokes and up to 25% of those that occur in young adults. We present a clinical case, in which this rare cause of dissection is observed using dynamic computed tomography (CT) techniques. Due to his symptoms, a magnetic resonance angiography was performed, in which a crescent-like image was observed in the wall of the right internal carotid artery, prior to its entry into the carotid foramen, compatible with carotid dissection. The evaluation was complemented with CT angiography, in which it was also found that the length of both styloid processes was increased (right 47 mm and left 44 mm). Using a dynamic CT angiography technique, in which the patient was placed in the supine position, obtaining images at rest and then in rotation and right lateral tilt, a compression of the ipsilateral internal carotid artery was observed between the styloid process and the corresponding paravertebral space, with a reduction in its caliber, identifying this anomaly as the cause of arterial dissection. These findings were characterized as Eagle syndrome in its vascular variant, also known as stylocarotid syndrome. Eagle syndrome should be considered in those patients with craniofacial pain, due to its classic variant, and in those patients with dissection of the internal carotid artery, due to its vascular variant. Dynamic CT angiography of the neck vessels turns out to be a fundamental tool for establishing an accurate diagnosis in stylocarotid Eagle syndrome, and highlighting the possible vascular compressions and consequent vascular injuries.