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Eagle syndrome is characterized by a variety of cervico-facial symptoms, predominantly pain and discomfort, due to compression of adjacent structures by an elongated styloid process. A constellation of neurological symptoms from impingement of the cranial nerves, the sympathetic trunk, and nearby structures may produce carotid artery dissection, cerebral venous sinus thrombosis (CVST), or concomitant ischemic stroke. We report on two cases of Eagle syndrome.

Case 1: A 38-year-old female with right cerebellar ischemic stroke secondary to patent foramen ovale status post closure presented with a 3-day history of left sided headache. She endorsed pain over her left cheek while brushing her teeth. Exam showed a mild left eye ptosis. Non-contrast head CT scan showed hyperdensity along the left transverse sinus concerning for CVST. Subsequent CT venogram confirmed the diagnosis. Laboratory work up for hypercoagulable conditions were negative. CT angiogram of the neck showed elongated left styloid process compressing the left internal jugular vein. MRI brain showed no ischemia. She was treated with intravenous heparin as an inpatient and discharged on direct oral anticoagulant.

Case 2: A 43-year-old male without significant prior medical history presented with left eye ptosis and left sided facial pain. Exam demonstrated left eye ptosis and miosis. MRI brain showed no ischemia.MRA head and neck demonstrated left internal carotid dissection. CT angiogram of the head and neck with contrast showed elongated styloid process abutting the left internal carotid artery with distal pseudoaneurysm. Patient was treated with intravenous heparin as an inpatient.The patient was discharged on dual antiplatelet therapy. The progressive paratrigeminal oculosympathetic syndrome was thought to be consistent with Raeder syndrome.