Document Type

Conference Proceeding

Publication Date

5-2026

Abstract

Clinical History 41-year-old male with no prior relevant medical history presented to the emergency department with severe neck pain and occipital headaches radiating bilaterally to the temporal regions. He also reported diplopia and “tunnel vision.” He had presented two weeks earlier with similar symptoms and was advised outpatient follow-up. Initial CT head and cervical spine were unremarkable. Imaging Findings Brain MRI/MRV demonstrated heterogeneous signal and enhancement in the left transverse and sigmoid sinuses and jugular bulb, initially thought to reflect possible motion artifact. However, CT venography was recommended for further assessment. The MRI also showed subtle left posterior occipital subdural hemorrhage. CT venogram revealed bilateral elongated styloid processes (3.2 cm), with significant compression of the proximal left internal jugular vein at the level of the cranio-cervical junction. Small filling defects were identified in the left transverse and sigmoid sinuses and jugular bulb. A repeat MRV without motion artifact confirmed findings consistent with nonocclusive dural venous sinus thrombosis. Discussion Eagle syndrome refers to symptomatic elongation of the styloid process or calcification of the stylohyoid ligament. It is critical to distinguish this from asymptomatic elongation, which is commonly seen incidentally on imaging. A subset, known as styloidogenic jugular venous compression syndrome, can result in venous outflow obstruction, with clinical manifestations ranging from chronic headaches to pseudotumor cerebri. In this case, CT venography revealed left internal jugular vein compression at the craniocervical junction level by a 3.2 cm left styloid process, with associated nonocclusive dural venous sinus thrombosis . These imaging findings correlated with the patient’s occipital headaches and visual symptoms, meeting the threshold for Eagle syndrome. Initial MRV demonstrated heterogeneous signal in the left dural sinuses, initially attributed to motion artifact. CT venography clarified this by confirming thrombus and identifying the underlying structural cause. This case underscores the diagnostic value of cross-sectional venography in cases of equivocal MRV, and reinforces that Eagle syndrome should only be diagnosed when there is both anatomic compression and attributable symptoms. Teaching Point In patients with dural venous sinus thrombosis and no clear hypercoagulable risk factors, consider extrinsic venous compression from elongated styloid processes, known as styloidogenic jugular venous compression syndrome as an underrecognized but surgically treatable cause. Importantly, Eagle syndrome should only be diagnosed when there is both anatomic compression and corresponding symptoms or complications such as headaches or thrombosis as in our case.

First Page

81

Last Page

81

Comments

American Society of Neuroradiology ASNR26 Conference, May 17-20, 2026, Austin, TX

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