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IMAGES IN NEUROLOGY

Eagle Syndrome
An Unusual Cause of Head and Neck Pain

E
AGLE SYNDROME IS COMMENT Though already known to oto-
characterized by re- laryngologists, we hope to increase
current pain in the Eagle syndrome comprises clinical awareness of Eagle syndrome among
oropharynx and face symptoms arising from an elon- neurologists because it is a treat-
due to an elongated gated styloid process or calcified able entity different from glossopha-
styloid process or calcified stylohy- stylohyoid ligament. Otolaryn- ryngeal neuralgia.
oid ligament.1 It must be differenti- gologist W. W. Eagle described
ated from glossopharyngeal neural- the syndrome in 1937 based on Christina K. Sun, MD
gia. We aim to bring Eagle syndrome review of previous communica- Vince Mercuri, MMed, FRANCZR
to the attention of neurologists be- tions and personal cases. 2 Com- Mark J. Cook, MD, FRACP
cause it is underrepresented in neu- plaints include throat pain, for-
rological literature. We present a case eign body sensation, dysphagia,
of a man with left mastoid pain; com- and facial pain,1 often radiating to Correspondence: Dr Sun, Depart-
puted tomographic scan revealed ex- the mastoid or ear.3 Syncope has ment of Neurology, Centre for Clini-
tensive stylohyoid ligament ossifi- also been reported.3 Diagnosis is cal Neurosciences and Neurologi-
cation bilaterally. With appropriate based on history, clinical exami- cal Research, St Vincent’s Hospital
clinical history and radiography, nation, and radiography. Palpa- Melbourne, PO Box 2900, Fitzroy
Eagle syndrome can usually be iden- tion of the styloid process in the VIC 3065, Australia (christinaksun
tified and treated. tonsillar fossa indicates elongation @yahoo.com).
because normal processes are not Author Contributions: Study con-
palpable.1 Panoramic radiography cept and design: Sun and Cook. Ac-
REPORT OF A CASE
of the mouth or computed tomog- quisition of data: Mercuri. Analysis
raphy of the skull base and neck and interpretation of data: Sun and
A 25-year-old man was seen with 3 are the preferred radiographic Mercuri. Drafting of the manuscript:
years of left mastoid pain radiating studies. 4 Medical management Sun. Critical revision of the manu-
to the ear. The pain was constant and includes analgesics, anticonvul- script for important intellectual con-
aching; it peaked over minutes and sants, antidepressants, and local tent: Mercuri and Cook. Administra-
lasted days. Mouth opening, sneez- infiltration with steroids or anes- tive, technical, and material support:
ing, and head turning precipitated thetic agents. 4 Patients who fail Sun, Mercuri, and Cook.
episodes. Head turning occasion- medical therapy may benefit from
ally triggered presyncope. Neuro- surgical removal of the elongated REFERENCES
logical examination and brain mag- portion of the styloid process.1
netic resonance imaging were The pathophysiological mecha- 1. Murtagh RD, Caracciolo JT, Fernandez G. CT find-
unremarkable. Diagnosis was sus- nisms contributing to Eagle syn- ings associated with eagle syndrome. AJNR Am J
pected based on clinical history. drome remain controversial and Neuroradiol. 2001;22:1401-1402.
2. Eagle WW. Elongated styloid processes: report of
Head computed tomography re- include glossopharyngeal nerve two cases. Arch Otolaryngol. 1937;25:584-587.
vealed extensive stylohyoid liga- compression, pharyngeal mucosa 3. Bruyn GW. Stylohyoid syndrome (Eagle). In: Vinken
ment ossification bilaterally irritation by posttonsillectomy PJ, Bruyn GW, Klawans HL, Rose FC, eds. Hand-
(Figure). Over-the-counter pain scarring, and callus formation book of Clinical Neurology. Vol 4. Amsterdam, the
medications and valproate sodium from prior styloid fracture. 1 Netherlands: Elsevier Science Publishers BV; 1986:
501-514.
were ineffective, though local hot- Carotid vessel impingement and 4. Slavin KV. Eagle syndrome: entrapment of the glos-
pack application provided improve- irritation of sympathetic nerves sopharyngeal nerve? case report and review of the
ment. The patient refused surgery. have also been proposed.3 literature. J Neurosurg. 2002;97:216-218.

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A B

Figure. Reformatted coronal maximum intensity projection image (A) and volume-rendered reconstruction in bone window (B) of the upper neck data set,
demonstrating near-complete stylohyoid ligament (arrows) ossification, extending from the styloid process tip to the lesser cornu of the hyoid bone bilaterally.

(REPRINTED) ARCH NEUROL / VOL 63, FEB 2006 WWW.ARCHNEUROL.COM


295

©2006 American Medical Association. All rights reserved.