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TP059 ICU MANAGEMENT, MECHANICAL VENTILATION, AND CARDIAC CRITICAL CARE CASE REPORTS / The matic P os ter Ses sio n
A Rare Variant of Eagle's Syndrome
A. Shahzadi1, D. Kumar2, Z. Khan3, M. Bachan4, R. Siegel1; 1Internal Medicine, James J. Peters VAMC, Bronx, NY,
United States, 2Medicine, James J Peters VA Medical Center, Bronx, NY, United States, 3James J. Peters VAMC,
BRONX, NY, United States, 4JJP VA MEDICAL CENTER, BRONX, NY, United States.
Introduction: Eagle’s syndrome(ES) is a rare condition associated with abnormality/ossification of styloid
process. We report a case of young male who was found to have internal jugular venous stenosis (IVJS) due to
extrinsic compression by styloid process. Case Report: 25-years-old male with no significant history presented
with left-sided neck and jaw pain with associated left-sided headache. He als o reported photophobia and chronic
posterior neck pain. Physical examination was remarkable for left sided neck and jawline tenderness. Laboratory
findings were within normal limits. Possibility of subarachnoid hemorrhage and CNS infections was ruled out with
normal CSF and no aneurysm on CT-Angiogram (CTA). CTA neck revealed reflux of contrast into left jugular vein
with abrupt cut off at the proximal aspect and complete opacification of the right jugular vein resulting in
asymmetric opacification. Patient was started on therapeutic enoxaparin for possible venous thrombosis which
was ruled out by Magnetic Resonance Venography (MRV) Brain which did reveal poor flow related signal within
the left internal jugular vein below the skull base, likely relating to compression between the styloid process and
C1 vertebral body, with compensatory increased drainage through the left pterygoid and vertebral venous
plexuses [Figure 1]. Patient reported res olution of symptoms during admission and was discharged with
neurosurgery follow-up for possible decompression or stenting. Discussion: Eagle defined two syndromes
associated with an elongated styloid process, classic syndrome and Stylo-carotid syndrome. Classic syndrome is
characterized by pain and dysphagia, and carotid variant refers to stenosis or dissection of internal carotid
artery caused by compression by styloid process. In both syndromes, styloid process length seems to be the
major cause. However, literature describes another very rare variant, Stylo-Jugular variant as in our case. IVJS
secondary to compression between elongated styloid process coursing adjacent to the transverse process of
C1, causing venous reflux obstruction has been termed stylo-jugular ES. Extrinsic compression of IJV especially
by styloid process is one of the important etiologies of IJVS. Ipsilateral pain is usually more significant symptom.
Headache, numbness, and dizziness are usually chronic and may be related to the impaired cerebral venous
outflow. MRV is preferable to CT Venography in terms of accuracy of diagnosis. The treatment is usually
conservative, especially when symptoms are not invalidating and apparently controlled by medical treatment.
Jugular stenting has been reported to show benefit. More investigation is warranted to study the symptoms and
treatment of this condition.
This abstract is funded by: None
Am J Res pir Crit Ca re Med 2021;203:A2999
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