Atypical presentation of Eagle syndrome with hypoglossal nerve palsy and Horner syndrome.

BACKGROUND Many nerve injuries have been associated with Eagle syndrome. The cranial nerves V, VII, IX, and X have been reported to be injured by the elongated styloid process in this syndrome. METHODS We describe a case of Eagle syndrome with atypical symptoms of hypoglossal nerve palsy and Horner syndrome. RESULTS A 56-year-old woman presented with right hypoglossal nerve palsy, right Horner syndrome, right neck pain, and symptoms mimicking transient cerebral ischemia. An angioscan showed elongated styloid process bilaterally with the right process compressing the right carotid artery causing a 75% stenosis. After an en bloc resection of the right styloid process, there were no further episodes of paresthesias. The neck pain completely disappeared, as well as the Horner syndrome. As for the hemitongue, the fasciculations disappeared but the atrophy remained. CONCLUSION This is the first Eagle syndrome case report describing a motor paralysis of a cranial nerve.