Elongated Styloid Process as a Cause of Transient Ischemic Attacks

A 49-year-old man had been experiencing transient right-sided weakness during neck rotation and flexion to the left for 1 year. On hospital admission, a neurological examination revealed no deficits. Initialmagnetic resonance imaging of the brainwas unremarkable. The first computed tomographic (CT) angiographyof thebrain and neck revealed no abnormal findings. Catheter cerebral angiography,performedwiththepatient’sheadturnedtothe left (Figure1), demonstrated a filling defect fromwhat appears to be an extrinsic compression.ThesecondCTangiographyof thebrainandneckperformed with the patient’s head turned to the left (Figure 2 and Figure 3) revealed a left cervical internal carotid artery (ICA) compression due to an elongated styloid process. The elongated styloidprocesswasremovedduringsurgery,afterwhichthepatienthad a satisfactory recovery. Postoperative CT angiography of the brain and neck (Figure 4) revealed that the left cervical ICA was free of compression. This case suggests the usefulness of dynamic catheter and CT angiography for the diagnosis of an elongated styloid process as a cause of transient ischemic attack.