Internal Carotid Artery Dissection Secondary to an Elongated Styloid Process: A Case Report of Major Acute Ischemic Stroke (NIHSS 23)
This case report describes a 54-year-old patient who suffered a severe acute ischemic stroke (NIHSS 23) caused by an internal carotid artery dissection secondary to an elongated styloid process, highlighting the need for therapeutic strategies focused on stabilization, recurrence prevention, and rehabilitation.
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The brain is a delicate organ that relies on a constant, unbroken flow of blood to function. When a major artery supplying the brain is damaged, the result can be a stroke, a sudden event where brain tissue begins to die from lack of oxygen. One way this damage occurs is through a dissection, a tear in the inner lining of an artery that allows blood to seep into the vessel wall, creating a blockage or a clot that stops blood from reaching the brain. While some of these tears happen spontaneously or from severe trauma like a car crash, there is a rare anatomical cause that can turn a routine movement into a life-threatening injury. In some people, a bony spike at the base of the skull, known as the styloid process, grows longer than usual. Normally, this bone is harmless, but if it extends too far, it can press against the internal carotid artery, the main pipeline feeding the brain. This condition, often called Eagle syndrome, can wear down the artery wall over time or snap it open with a sudden twist of the neck, leading to a catastrophic blockage.
A team of medical professionals recently documented a dramatic case where this specific anatomical flaw caused a severe stroke in a 54-year-old man. The patient arrived at a hospital after a car accident, suffering from a massive blockage in the left internal carotid artery. His condition was critical; he had lost the ability to move his right arm and leg, his speech was impaired, and his neurological score indicated a severe stroke. Doctors at the first hospital attempted to dissolve the clot with medication, but it did not work. The patient was then transferred to a specialized neurology center in Bucharest for a more aggressive approach. There, a team of interventional specialists performed a mechanical thrombectomy, a procedure where a catheter is threaded through the blood vessels to physically pull the clot out. They successfully removed the initial blockage, but as they examined the artery more closely, they discovered the true culprit: a long, jagged tear running along the artery wall, caused by the bone pressing against it.
The situation was complicated by the patient's anatomy. The artery had a sharp loop near the tear, making it extremely difficult for the doctors to navigate their tools to the exact spot where the damage was worst. They managed to place a stent, a small mesh tube designed to hold the artery open, but only in the section before the difficult loop. The procedure restored some blood flow, but not enough to fully save the brain tissue in the affected area. In the days that followed, the patient's condition stabilized, though he remained with significant disabilities. Further imaging confirmed the diagnosis: an elongated styloid process was directly touching and damaging the artery, a classic sign of the vascular form of Eagle syndrome. The medical team had to restart blood-thinning medication when they noticed the stent was beginning to clog again, a common risk when placing metal devices in damaged arteries.
This case highlights the complex challenge of treating strokes caused by structural abnormalities. While the doctors managed to clear the immediate blockage and prevent the situation from becoming fatal, the underlying damage to the artery meant that full recovery was unlikely. The patient eventually improved enough to move his right side and swallow food again, though he still required assistance. The medical team concluded that while their intervention saved his life, the only way to prevent a recurrence would be to surgically remove the offending bone, a step that was not taken during this acute phase. The report serves as a reminder that for some patients, a stroke is not just a random event but the result of a specific, physical collision between a bone and a blood vessel, requiring a tailored approach that goes beyond standard clot removal. The authors note that such cases are rare, and while surgery to remove the bone is an option for those who suffer repeated attacks, the decision must be made carefully by a team of specialists weighing the risks and benefits for each individual.
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