Vascular Eagle syndrome presenting with expanding cervical hematoma and acute ischemic stroke causing impending airway compromise.

INTRODUCTION

Eagle syndrome is a rare condition resulting from elongation of the styloid process or ossification of the stylohyoid ligament. While the classical variant typically presents with cervicofacial pain and dysphagia, the vascular variant may lead to compression or injury of adjacent vascular structures, resulting in transient ischemic attack, arterial dissection, or ischemic stroke. Hemorrhagic vascular complications associated with Eagle syndrome are extremely uncommon.

CASE PRESENTATION: A 26-year-old female presented to the emergency department with rapidly progressive swelling on the right side of the neck associated with respiratory distress. Initial assessment revealed stridor and persistent hypoxia with oxygen saturation of 80% despite oxygen supplementation. Physical examination demonstrated a tense, expanding cervical swelling with tracheal deviation, raising concern for impending airway compromise. Intubation was attempted under sedation; however, the patient developed hypoxic bradycardia during the procedure. Oxygenation was restored using a supraglottic airway device while preparation for emergency front-of-neck access was undertaken. CT angiography revealed a fractured elongated styloid process measuring approximately 60 mm, aneurysmal dilatation of the occipital branch of the external carotid artery, and a large cervical hematoma compressing adjacent vascular structures. CT brain demonstrated right subcortical infarction involving the corona radiata and internal capsule. The patient subsequently underwent emergency tracheostomy, evacuation of cervical hematoma, and ligation of the bleeding vessel. She was later discharged with minimal residual neurological deficits.

CONCLUSION

This case highlights a rare presentation of vascular Eagle syndrome producing simultaneous hemorrhagic airway compromise and ischemic stroke. Early recognition of airway compromise and prompt multidisciplinary intervention were essential for successful management.