Eagle syndrome with cranial nerves palsy

Case contributed by Dr Ammar Haouimi

Presentation

Right hemiatrophy of the tongue.

Patient Data

Age: 40 years
Gender: Male

There is a right hemiatrophy of the tongue with an elongation of both styloid processes mainly on the right, length= 7.8 cm on the right and 4.2 cm on the left (normally 2.5-3 cm) with associated ossification of the left stylohyoid ligament, extending caudally from the base of the skull up to the pharyngeal wall on the right and up to the hyoid bone on the left.

On the right, in addition to the elongation, there is a hypertrophy of the styloid process with reduced retrostyloid space, laminated internal jugular vein and probably compression of the adjacent segment of the glossopharyngeal (IX) and hypoglossal (XII) nerves.

Signs of left vocal cord palsy with no evidence of compression of the recurrent laryngeal or vagus nerve at the cervical region

  • enlarged left pyriform sinus
  • thickened with medial position of the aryepiglottic fold
  • medial rotation of the left arytenoid cartilage
  • dilated left laryngeal ventricle "sail sign"

Case Discussion

MRI features of Eagle syndrome with cranial nerves palsy. 

For the left vocal cord palsy, a chest CT was recommended to rule out compression of the recurrent laryngeal nerve or vagus nerve in the mediastinum.

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