ABSTRACT NUMBER: ESOC2026A1916 VASCULAR EAGLE SYNDROME AND CAROTID ARTERY DISSECTION: THREE CASES HIGHLIGHTING DIAGNOSTIC CHALLENGES AND MANAGEMENT CONSIDERATIONS

Abstract Background and aims Eagle syndrome is a rare condition caused by elongation of the styloid process or calcification of the stylohyoid ligament. Its vascular subtype, stylocarotid syndrome, may result in internal carotid artery (ICA) compression or dissection, leading to transient ischemic attack (TIA) or stroke. Although radiographic styloid elongation occurs in up to 28% of the population, fewer than 0.1% develop symptoms, making diagnosis challenging and often delayed. Methods We describe three patients presenting to our stroke unit with carotid dissection or ICA compression secondary to vascular Eagle syndrome. Clinical presentation, imaging characteristics, management, and outcomes were reviewed. Results Case 1: A 43-year-old woman presented with recurrent TIAs and bilateral ICA dissections, requiring carotid stenting and later re-intervention for restenosis. Case 2: A 37-year-old sailor developed isolated hypoglossal nerve palsy due to ICA dissection and was successfully treated with dual antiplatelet therapy. Case 3: A 55-year-old woman presented with amaurosis fugax and right hemiparesis secondary to left ICA dissection with hemodynamically significant stenosis and was stabilized on dual antiplatelet therapy. CTA with 3D reconstruction confirmed elongated styloid processes contacting the ICA in all cases. During 6–18 months of follow-up, no patient experienced recurrent stroke. Conclusions Vascular Eagle syndrome should be considered in unexplained carotid dissection, cranial neuropathy, or posture-dependent ischemia. CTA with 3D reconstruction is essential for diagnosis. While medical therapy may be sufficient in stable cases, carotid stenting represents an important option in recurrent or hemodynamically significant disease. Increased awareness may improve recognition and prevent stroke in this rare entity. Conflict of interest Amro Biadsee: nothing to disclose