ES Information- A Scary Subject
Disclaimer: These answers to common questions were put together for new members to gain a head start in finding information about Eagle Syndrome; to give you confidence to discuss issues with your medical team and to encourage you to research issues further for yourselves. It was compiled by a volunteer Moderator, who does not claim to be a medical professional, merely an informed observer and patient! The sources used are personal experiences, LivingWithTheEagle members’ experiences, and research from professional publications (some of the articles can’t be read fully unless subscribed to). Many thanks to heidemt for her research and contribution, and for her example of being your own advocate and not giving up. Members are encouraged to seek medical opinion and these pages are not intended to replace that. Members are also encouraged to research more for themselves- there is more research available but with the limitation of time and neck pain, this was the best that I could do! Past discussions are useful sources of info as well; search whatever the subject is, and you’ll often find someone who’s been through it too!
Can ES cause a stroke, or be fatal?
Unfortunately the answer is yes, but fortunately this is extremely rare and there have only been a few documented cases:
‘A 60-year-old patient is presented who developed a stroke related to a bilateral internal carotid artery dissection due to elongated styloid processes and intense jerky head movements during unwonted shaking dance. The association between elongated styloid process and cervicofacial pain is well known as Eagle’s syndrome but its association with stroke is exceptional. To our knowledge, this case is the first observation of bilateral carotid artery dissection related to elongated styloid processes and demonstrates that cervical CT angioscan is a very efficient non-invasive method of diagnosing this rare condition.’ (Bilateral internal carotid artery dissection due to elongated styloid processes and shaking dancing by Faivre, Abdelfettah, Rodriguez, and Nicoli, 2008).
And also: ‘We describe two cases of internal carotid artery dissection associated with an elongated SP. One is a patient with ischaemic stroke and another with transient ischaemic attacks caused by an elongated SP. A surgical resection of the SP was performed on the former patient. Both patients were treated with anticoagulation and recovered well.
A literature search only revealed two prior descriptions of carotid dissection in the context of an elongated SP.’ (Internal Carotid Dissection Caused By An Elongated Styloid Process- Eagle Syndrome- by Sveinsson, Olafur; Kostulas, Nikolaos; Herrman, Lars, 2013).
Also in their research on calcification the authors state ‘It may also cause stroke due to the compression of carotid arteries.’- Styloid Process Elongation or Eagle’s Syndrome: Is There Any Role for Ectopic Calcification? By Gokce, Sisman, and Sipahioglu.
Another piece of research states that ‘The elongated styloid process was appreciated during the postmortem examination, and the diagnosis of sudden death due to mechanical irritation of the carotid sinus by elongated styloid process was made as the sign of acute cardiovascular failure was present and upon exclusion of other causes of death.’ Sudden death due to Eagle Syndrome, by Kumar et al, 2013 ( )http://www.ncbi.nlm.nih.gov/pubmed/23949139
One member, R.B., posted a really good explanation a while back, which unfortunately seems to have disapppeared with the new site changeover, from the article: http://www.ncbi.nlm.nih.gov/pubmed/19051675. This is a research article on the case of a lady who died ‘of probable vagus mediated cardiac inhibition due to Eagle’s syndrome. The diagnosis was established only after the autopsy examination, which revealed the elongation of the styloid processes in the form of fibrous membranes, compressing both carotid sinuses. The anatomical changes were not visible in the radiological films.’
Other research mentioning this are: Chuang WC, Short JH, McKinney AM, et al. ‘Reversible left hemispheric ischemia secondary to carotid compression in Eagle syndrome: surgical and CT angiographic correlation’,2007; and Farhat HI, Elhammady MS, Ziayee H, et al. ‘Eagle syndrome as a cause of transient ischemic attacks’, 2009.
There is also a case of ES causing a ‘pseudo aneurysm’ in the report: ‘Eagle syndrome presenting with external carotid artery pseudoaneurysm’, by Dao, Karnezis, Lane, Fujitani and Saremi; where the sharpened tip of a styloid process impinged on the ECA.
In this report, there is also one mention of ES causing a sudden death: ‘Rarely, compression of both carotid sinuses by bilaterally elongated styloid processes can occur, potentially even leading to sudden death from vagus-mediated cardiac inhibition’ (Runwanpura PR, Abeygunasekera AM, Tikiri GK. ‘Sudden unexpected death probably due to Eagle’s syndrome: a case report.’ Med Sci Law. 2008) This cause of death was established after the post mortem, where bilateral elongated styloid processes were discovered compressing both carotid sinuses.
Chaung et al (2007) reported a man who had ischaemic episodes when his head was in certain positions- a CT angiogram with his head in that position revealed the styloid process completely blocking the ICA.
We have had several members with aneurysms/ pseudo-aneurysms in the carotid arteries caused by the styloid processes impinging on the artery:
see Chromechaser66’s comments in this discussion- ES experienced doctor in metro Detroit area?
and Joanna’s in this discussion: CT neck non-contrast “styloid protocol”?
Other members have found that they have had ‘heart attack-like symptoms’, and have been checked out at the ER, with no heart problems found. If the styloid process or calcified ligaments are compressing/ irritating the Vagus nerve, this nerve is responsible for control of heart rate and breathing, so irritation of it can cause tachycardia or other scary symptoms.
If in doubt it is always best to get these symptoms checked out, obviously.
Again, another discussion about ‘fake heart attacks’ can’t be found since the changeover, but I did find this one when member Ang1 (who did the survey) describes very well some scary symptoms – which were resolved with surgery: Two Month Post-Op Update