When the Eagle Strikes Twice: A Case Report of Recurrent Stroke Secondary to Bilateral Stylocarotid Artery Syndrome

Eagle syndrome (ES), particularly its vascular variant known as stylocarotid artery syndrome (SAS), is characterized by an elongated styloid process (ESP) that impinges on the internal carotid artery (ICA), leading to vascular complications. We report a case of a 57-year-old man who presented with acute left-sided weakness. Imaging revealed right ICA dissection (ICAD), which was medically managed. Six years later, the patient presented with acute right-sided weakness, and imaging revealed a new left ICAD. Further review of the imaging findings identified bilateral ESP as the underlying cause of both dissections. The patient underwent a left-sided styloidectomy and had an uneventful recovery. This case report describes a patient with vascular ES who experienced bilateral ICADs separated by several years. This underscores the importance of recognizing vascular ES as a potential and treatable cause of stroke.