Neurological Surgery No Shinkei Geka Volume 46, Issue 1 (January 2018)

Bilateral Internal Carotid Artery Dissection Caused by Elongated Styloid Processes:A Case Report Toru TAKINO 1 , Satoshi SHIBUMA 1 , Yu KANEMARU 1 , Koji OKAMURA 2 , Aki OSHIMA 2 , Manami TAZAWA 2 , Takeo NASHIMOTO 1 , Naoto TSUCHIYA 1 , Junichi YOSHIMURA 1 , Kiminori NETSU 2 , Takafumi SAITO 1 1Department of Neurosurgery, Nagano Red Cross Hospital 2Department of Otolaryngology, Nagano Red Cross Hospital Keyword: carotid artery dissection , elongated styloid process , Eagle syndrome , surgical resection , endoscopy pp.53-59
Published Date 2018/1/10
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 We report a case of bilateral internal carotid artery(ICA)dissection associated with bilateral elongated styloid processes(ESPs). A 46-year-old man presented with transient aphasia and left visual disturbance at a business meeting. He complained of a foreign body sensation in his throat during swallowing for two years. Magnetic resonance imaging(MRI)demonstrated fresh small infarcts in the left corona radiata. Magnetic resonance angiography(MRA)revealed string signs bilaterally in the cervical ICAs. The patient was diagnosed with bilateral idiopathic ICA dissection and was treated with ozagrel and clopidogrel. Three-dimensional computed tomographic angiogram(3DCTA)indicated bilateral ESPs and bilateral ICA stenosis. 3DCTA with the patient's head tilting and neck extension revealed that each ICA was compressed by the ipsilateral ESP. A follow-up MRA showed complete normalization of bilateral ICAs after neck rest and anti-platelet therapy, following which, clopidogrel was stopped. The patient wore a soft cervical collar until the operation, to avoid contact between the ESPs and ICAs due to changes in head position. Bilateral ESP resection was performed to prevent recurrence of cerebral ischemic events caused by ICA dissection. The patient was discharged one week after the surgery without any neurological deficit. There was no recurrence of symptoms during the next eight months after the operation.

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Neurological Surgery 脳神経外科
46巻1号 (2018年1月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院