Xu Wenlong, Song Gang, Bai Xuesong, Jiao Liqun
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China.
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; International Neuroscience Institute (China-INI), Beijing, China; Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
J Stroke Cerebrovasc Dis. 2023 May;32(5):107088. doi: 10.1016/j.jstrokecerebrovasdis.2023.107088. Epub 2023 Mar 20.
Elongated styloid process (ESP) and carotid web are rare etiologies of ischemic stroke. We report a rare case of ESP concomitant with carotid web as the cause of recurrent stroke.
A 59-year-old man was admitted to our hospital with recurrent numbness and weakness in the right upper extremity. The patient had a long-standing history of lightheadedness and left-side amaurosis with neck flexion. Magnetic resonance imaging (MRI) confirmed scattered infarctions in the left frontal and parietal lobes. After multi-modal imaging we determined that embolic cerebral infarction was most likely to be secondary to the carotid web. Moreover, ESP causes dynamic hypoperfusion during neck flexion. We believe that this is a good reason for dealing with both pathologies during the same surgery. Thus, carotid endarterectomy and styloid process resection were performed at the same time. The previous symptoms during the head position change did not recur, and the right hand weakness was resolved.
ESP and carotid web are unusual mechanisms of ischemic stroke. Early diagnosis and timely treatment are essential to prevent subsequent severe strokes.
茎突过长（ESP）和颈动脉蹼是缺血性卒中的罕见病因。我们报告一例罕见的ESP合并颈动脉蹼导致复发性卒中的病例。
一名59岁男性因右上肢反复出现麻木和无力入院。患者有长期头晕病史，颈部屈曲时出现左侧黑矇。磁共振成像（MRI）证实左侧额叶和顶叶有散在梗死灶。经过多模态成像检查，我们确定栓塞性脑梗死最可能继发于颈动脉蹼。此外，ESP在颈部屈曲时会导致动态低灌注。我们认为这是在同一手术中处理两种病变的充分理由。因此，同时进行了颈动脉内膜切除术和茎突切除术。头部位置改变时先前的症状未再出现，右手无力症状得到缓解。
ESP和颈动脉蹼是缺血性卒中的不常见病因。早期诊断和及时治疗对于预防随后的严重卒中至关重要。
