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Images in Neurology |

Elongated Styloid Process as a Cause of Transient Ischemic Attacks

Joon Ho Song, MD1; Sung Ki Ahn, MD1; Chul Bum Cho, MD2
[+] Author Affiliations
1Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
2Department of Neurosurgery, St Vincent’s Hospital, Catholic University of Korea, Gyeonggi-do, Korea
JAMA Neurol. 2013;70(8):1072-1073. doi:10.1001/jamaneurol.2013.1950.
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A 49-year-old man had been experiencing transient right-sided weakness during neck rotation and flexion to the left for 1 year. On hospital admission, a neurological examination revealed no deficits. Initial magnetic resonance imaging of the brain was unremarkable. The first computed tomographic (CT) angiography of the brain and neck revealed no abnormal findings. Catheter cerebral angiography, performed with the patient’s head turned to the left (Figure 1), demonstrated a filling defect from what appears to be an extrinsic compression. The second CT angiography of the brain and neck performed with the patient’s head turned to the left (Figure 2 and Figure 3) revealed a left cervical internal carotid artery (ICA) compression due to an elongated styloid process. The elongated styloid process was removed during surgery, after which the patient had a satisfactory recovery. Postoperative CT angiography of the brain and neck (Figure 4) revealed that the left cervical ICA was free of compression. This case suggests the usefulness of dynamic catheter and CT angiography for the diagnosis of an elongated styloid process as a cause of transient ischemic attack.

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Figure 1.
Catheter Cerebral Angiogram

Obtained with the patient’s head turned to the left, the angiogram demonstrates a filling defect from what appears to be an extrinsic compression (arrow).

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Figure 2.
Second Computed Tomographic Angiogram of the Brain

Obtained with the patient’s head turned to the left, the angiogram reveals a left cervical internal carotid artery compression due to the elongated styloid process (arrow).

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Figure 3.
Second Computed Tomographic Angiogram of the Neck

Obtained with the patient’s head turned to the left, the angiogram reveals a left cervical internal carotid artery compression due to the elongated styloid process (arrow).

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Figure 4.
Postoperative Computed Tomographic Angiogram of the Brain and Neck

The angiogram shows a left cervical internal carotid artery free of compression (arrow).

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