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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.
Song JH, Ahn SK, Cho CB. Elongated Styloid Process as a Cause of Transient Ischemic Attacks. JAMA Neurol. 2013;70(8):1072-1073. doi:10.1001/jamaneurol.2013.1950