Eagle syndrome

Case contributed by Dr David Matthews

Presentation

Two weeks of right sided headache. Right side (partial) ptosis.

Patient Data

Age: 55 years
Gender: Male

CT Neck

CT

Right ICA dissection. Note elongated right styloid process in contact wih ICA. 

Diagram

Cervical sympathetic chain anatomy. Compression of post ganglionic sympathetic nerve fibers can cause a partial ptosis (if with miosis and anhydrosis = Horners Syndrome). 

Image from American Academy of Opthamology, 2020, Horner Syndromw, viewed 16 April 2020,https://www.aao.org/oculoplastics-center/horner-syndrome-8

Treatment was conservative/medical. 

Subsequent MRI head and neck - NAD. Resolution of dissection. No intracranial infarction. Ptosis resolved. 

Case Discussion

Rare but recognized complication of a congenitally long styloid process.

Useful to think about the anatomy underlying the patients partial ptosis. 

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