Vascular Eagle syndrome with internal carotid artery occlusion and cranial nerve palsies in a young adult: a case report

Vascular Eagle syndrome refers to carotid or jugular disease associated with an elongated styloid process or an ossified stylohyoid complex. A 26-year-old man had an 8-year history of rightward tongue deviation and dysarthria, with hoarseness developing later. Three months before surgery he developed headache, dizziness, and left-sided limb numbness; imaging showed multifocal acute ischemic lesions in the right cerebral hemisphere. Magnetic resonance angiography revealed thrombotic occlusion of the right internal carotid artery (ICA) at C1–C2, and follow-up computed tomography angiography showed severe focal stenosis with a residual filling defect and a smaller right ICA. Computed tomography demonstrated an elongated right styloid process measuring approximately 3.3 cm adjacent to the artery. He underwent transcervical resection of the styloid process after antiplatelet and lipid-lowering therapy. Limb numbness improved after surgery, but the tongue deviation and hoarseness did not. At 1-year follow-up, imaging showed resection of the styloid process and partial resolution of the right ICA filling defect. This report describes an unusual presentation of suspected vascular Eagle syndrome involving right ICA occlusion and cerebral infarction, accompanied by chronic tongue deviation and hoarseness. The neurological findings were compatible with hypoglossal and possible recurrent laryngeal nerve dysfunction, although their relationship to the elongated styloid process could not be established.