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Article(id=1198202431453622816, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198202427301265552, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.0044.2024.0506, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1704902400000, receivedDateStr=2024-01-11, revisedDate=null, revisedDateStr=null, acceptedDate=1706544000000, acceptedDateStr=2024-01-30, onlineDate=1763603321183, onlineDateStr=2025-11-20, pubDate=1730044800000, pubDateStr=2024-10-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763603321183, onlineIssueDateStr=2025-11-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763603321183, creator=13701087609, updateTime=1763603321183, updator=13701087609, issue=Issue{id=1198202427301265552, tenantId=1146029695717560320, journalId=1189873630562394117, year='2024', volume='49', issue='10', pageStart='1099', pageEnd='1220', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1763603320193, creator=13701087609, updateTime=1763603941762, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1198205034396746241, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198202427301265552, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1198205034396746242, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198202427301265552, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1156, endPage=1162, ext={EN=ArticleExt(id=1198202431688503847, articleId=1198202431453622816, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Clinical characteristics of 2 cases of styloid-carotid artery syndrome and literature review, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To summarize the clinical characteristics of 2 cases of styloid-carotid syndrome(SCS) and review the literature to enhance understanding of the disease. Methods A retrospective analysis was conducted on the clinical manifestations, auxiliary examinations, and diagnosis and treatment of 2 patients with SCS admitted to the Neurology Department of Kaifeng Central Hospital. Additionally, relevant literature was searched through domestic and foreign databases such as PubMed, WOS, Embase, CNKI and VIP. The clinical characteristics of SCS were summarized based on the literature results. Results The 2 cases were diagnosed as transient cerebral ischemia (TIA) combined with SCS through head and neck CT angiography (CTA) and styloid process CT. Apart from the 2 cases treated in our hospital, a total of 11 cases of SCS have been reported in Chinese and English literature up to October 2023. Among the 13 cases, 11 cases (84.6%) started with episodic TIA symptoms, and 11 cases (84.6%) had obvious inducing factors related to specific head position changes. Common clinical manifestations included unilateral limb weakness with or without sensory disturbance (10 cases, 76.9%), slurred speech (7 cases, 53.8%), unilateral limb sensation disorder (4 cases, 30.7%), syncope (3 cases, 23.1%) and amaurosis (2 cases, 15.4%). All 13 cases underwent 64-row head and neck CTA examination, and 6 cases (46.2%) dynamically observed the changes in blood flow velocity through examinations such as transcranial Doppler ultrasound (TCD), cervical vascular ultrasound, and digital subtraction angiography (DSA). All patients were followed up for more than 3 months; and 10 cases (76.9%) achieved clinical cure after treatment, of which 8 cases underwent styloid process shortening surgery; 3 cases (23.1%) achieved clinical symptom improvement after treatment. Conclusions For patients with recurrent TIA and/or cerebral infarction, it is necessary to identify whether there are inducing factors related to specific body position changes. For patients highly suspected of SCS, routine examinations such as styloid process CT and 64-row head and neck CTA should be performed, and if necessary, whole brain DSA, dynamic TCD and/or carotid ultrasound should be conducted to guide the diagnosis and treatment. When non-surgical treatment is ineffective, radical styloid process truncation can be considered as a treatment option.

, correspAuthors=Yong-Lin Jia, authorNote=null, correspAuthorsNote=
E-mail:
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目的 总结茎突-颈动脉综合征2例的临床特点并文献复习，以提高对该病的认识。方法 回顾性分析开封市中心医院神经内科收治的2例茎突-颈动脉综合征患者的临床表现、辅助检查及诊治经过，并通过PubMed、WOS、Embase、中国知网及维普等国内外数据库检索相关文献。综合文献结果，总结茎突-颈动脉综合征的临床特点。结果 2例经头颈CT血管成像(CTA)和茎突CT等检查确诊为短暂性脑缺血(TIA)合并茎突-颈动脉综合征。除本院收治的2例外，中英文文献共报道11例茎突-颈动脉综合征患者(截至2023年10月)。13例中，11例(84.6%)以发作性的TIA症状起病，11例(84.6%)有明显的特殊头位变化的诱发因素。该病常见临床表现为单侧肢体力弱伴或不伴感觉障碍(10例，76.9%)、言语不清(7例，53.8%)、单侧肢体感觉障碍(4例，30.7%)、晕厥(3例，23.1%)、黑曚(2例，15.4%)。13例均行64排头颈CTA检查，6例(46.2%)通过经颅多普勒超声(TCD)、颈部血管超声及数字减影血管造影(DSA)等检查动态观察了血流速度变化情况。所有患者均随访观察>3个月，10例(76.9%)经治疗后达临床治愈，其中8例行茎突截短术；3例(23.1%)经治疗后达临床症状缓解。结论 对于反复TIA或脑梗死发病患者，应了解有无特殊体位变换相关的诱发因素；对高度怀疑茎突-颈动脉综合征患者，应常规行茎突CT、64排头颈CTA检查，必要时行全脑DSA、动态TCD或颈部血管超声等检查，以指导诊治。非手术治疗效果不佳时，可考虑行茎突截短术治疗。

, correspAuthors=贾永林, authorNote=null, correspAuthorsNote=
贾永林，E-mail：
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高成恩，医学硕士，主治医师，主要从事重症脑血管病、中枢神经系统感染性疾病方面的研究

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高成恩，医学硕士，主治医师，主要从事重症脑血管病、中枢神经系统感染性疾病方面的研究

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高成恩，医学硕士，主治医师，主要从事重症脑血管病、中枢神经系统感染性疾病方面的研究

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Contemp Clin Dent, 2012, 3(4): 503-506., articleTitle=Stylocarotid syndrome: an unusual case report, refAbstract=null), Reference(id=1198319042051277500, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198202431453622816, doi=null, pmid=null, pmcid=null, year=2019, volume=16, issue=3, pageStart=150, pageEnd=152, url=null, language=null, rfNumber=[6], rfOrder=5, authorNames=董佳, 宋庆斌, 王玉林, journalName=中国脑血管病杂志, refType=null, unstructuredReference=董佳, 宋庆斌, 王玉林, 等. 复合手术治疗颈动脉茎突综合征一例并文献复习[J]. 中国脑血管病杂志, 2019, 16(3): 150-152., articleTitle=复合手术治疗颈动脉茎突综合征一例并文献复习, refAbstract=null), Reference(id=1198319042168718015, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198202431453622816, doi=null, pmid=null, pmcid=null, year=2014, volume=60, issue=6, pageStart=1661, pageEnd=1663, url=null, language=null, rfNumber=[7], rfOrder=6, authorNames=David J, Lieb M, Rahimi SA, journalName=J Vasc Surg, refType=null, unstructuredReference=David J, Lieb M, Rahimi SA. 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Head Neck, 2014, 36(12): E136-E138., articleTitle=Atypical presentation of Eagle syndrome with hypoglossal nerve palsy and Horner syndrome, refAbstract=null), Reference(id=1198319042370044614, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198202431453622816, doi=null, pmid=null, pmcid=null, year=2017, volume=23, issue=4, pageStart=433, pageEnd=436, url=null, language=null, rfNumber=[9], rfOrder=8, authorNames=Smoot TW, Taha A, Tarlov N, journalName=Interv Neuroradiol, refType=null, unstructuredReference=Smoot TW, Taha A, Tarlov N, et al. Eagle syndrome: a case report of stylocarotid syndrome with internal carotid artery dissection[J]. 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J Neurosurg Case Lessons, 2021, 1(26): CASE21286., articleTitle=Eagle syndrome with hidden stylocarotid syndrome examined using dynamic ultrasonography: illustrative case, refAbstract=null), Reference(id=1198319042701394640, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198202431453622816, doi=null, pmid=null, pmcid=null, year=2023, volume=31, issue=null, pageStart=100462, pageEnd=null, url=null, language=null, rfNumber=[13], rfOrder=12, authorNames=Amir MA, Rehman IU, Riaz U, journalName=eNeurologicalSci, refType=null, unstructuredReference=Amir MA, Rehman IU, Riaz U, et al. Battling the Eagle's sharp beak, Eagle syndrome; a case report[J]. eNeurologicalSci, 2023, 31: 100462., articleTitle=Battling the Eagle's sharp beak, Eagle syndrome; a case report, refAbstract=null), Reference(id=1198319042764309202, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198202431453622816, doi=null, pmid=null, pmcid=null, year=2017, volume=159, issue=null, pageStart=34, pageEnd=38, url=null, language=null, rfNumber=[14], rfOrder=13, authorNames=Badhey A, Jategaonkar A, Anglin Kovacs AJ, journalName=Clin Neurol Neurosurg, refType=null, unstructuredReference=Badhey A, Jategaonkar A, Anglin Kovacs AJ, et al. Eagle syndrome: a comprehensive review[J]. Clin Neurol Neurosurg, 2017, 159: 34-38., articleTitle=Eagle syndrome: a comprehensive review, refAbstract=null), Reference(id=1198319042827223764, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198202431453622816, doi=null, pmid=null, pmcid=null, year=2020, volume=75, issue=2, pageStart=21, pageEnd=27, url=null, language=null, rfNumber=[15], rfOrder=14, authorNames=Wacławek M, Pietkiewicz P, Niewiadomski P, journalName=Otolaryngol Pol, refType=null, unstructuredReference=Wacławek M, Pietkiewicz P, Niewiadomski P, et al. Own experience in the diagnosis and treatment of elongated styloid process syndrome[J]. 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RICA. 右侧颈内动脉；RECA. 右侧颈外动脉；R. 右侧；CTA. CT血管成像；A. 颈部动脉与茎突；B. 右侧茎突尖端距其内侧颈内动脉约0.27 cm

, figureFileSmall=ns50KgRXqLk35AydtkbdOg==, figureFileBig=yqU+ZM2WZWK73HfALFEXJA==, tableContent=null), ArticleFig(id=1198319038532256355, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198202431453622816, language=EN, label=Fig.2, caption=Blood flow velocity spectrum of the right internal carotid artery siphon under different head positions in TCD of case 1 of Eagle's syndrome, figureFileSmall=J354Urgt1R7RVr184ndzCw==, figureFileBig=exrRBpID8W4TP5bB1nqsyw==, tableContent=null), ArticleFig(id=1198319038649696874, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198202431453622816, language=CN, label=图2, caption=茎突-颈动脉综合征例1的TCD示不同头位下右侧颈内动脉虹吸部血流速度频谱

TCD. 经颅多普勒超声；头部正中位(A)、头部后仰位(B)和头部前屈位(C)血流无明显差异；D. 右下曲颈位峰值血流速度(Vs)和平均血流速度(Vm)均明显降低

, figureFileSmall=J354Urgt1R7RVr184ndzCw==, figureFileBig=exrRBpID8W4TP5bB1nqsyw==, tableContent=null), ArticleFig(id=1198319038746165871, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198202431453622816, language=EN, label=Fig.3, caption=Adjacent relationship between styloid process and carotid artery under 64 row head and neck CTA of case 2 of Eagle's syndrome, figureFileSmall=y0LR5WKJPZeOhfr8+iP96w==, figureFileBig=1dciZ4e3duGJLzIO8VdfTQ==, tableContent=null), ArticleFig(id=1198319038867800687, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198202431453622816, language=CN, label=图3, caption=茎突-颈动综合征例2的64排头颈CTA下茎突与颈动脉的毗邻关系

CTA. CT血管成像；A. 右侧茎突长度4.39 cm，左侧茎突3.25 cm；B. 右侧茎突尖端距其内侧颈内动脉0.22 cm，距外侧颈外动脉0.12 cm(标线所示)

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头部正中位(A)、头部后仰位(B)及头部前屈位(C)血流无明显差异；右侧曲颈位(D)峰值血流速度(Vs)和平均血流速度(Vm)均明显降低。

, figureFileSmall=K+/MtTZCvqIVKMqMI6hIDg==, figureFileBig=3hlMCmIXiCkM1Ecl5ISALw==, tableContent=null), ArticleFig(id=1198319039098487417, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198202431453622816, language=EN, label=Fig.5, caption=Anatomy of styloid process and carotid artery and their surrounding relationships, figureFileSmall=QgydPciO3IHqQycks+Z/5g==, figureFileBig=rPJjtiHPaIUUJdbGazot9Q==, tableContent=null), ArticleFig(id=1198319039194956413, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198202431453622816, language=CN, label=图5, caption=颈动脉、茎突解剖及其周围毗邻关系

A. 颈动脉；B. 茎突

, figureFileSmall=QgydPciO3IHqQycks+Z/5g==, figureFileBig=rPJjtiHPaIUUJdbGazot9Q==, tableContent=null), ArticleFig(id=1198319039304008322, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198202431453622816, language=EN, label=Tab.1, caption=

Clinical data of 13 patients with styloid-carotid artery syndrome

, figureFileSmall=null, figureFileBig=null, tableContent=
年度/国家文献年龄(岁)/性别临床表现诱发因素辅助检查位置治疗
2007/美国[2]77/男发作性右手麻木伴失语左侧转头、左下低头MRA、CTA左侧左侧茎突截短术
2012/美国[4]80/男头晕、晕厥转颈时CTA双侧双侧茎突截短术
57/男左侧颈部疼痛；头痛；一过性言语不清、右侧肢体瘫痪颈部按摩后MRA、CTA双侧抗凝+抗血小板聚集+颈动脉球囊扩张+颈动脉支架植入术
2014/美国[7]57/女发作性右侧肢体无力伴晕厥；左耳“嗖嗖”声右侧转颈、打哈欠CTA左侧左侧茎突截短术
2014/加拿大[8]56/女一过性左下面部感觉异常、一过性左下肢无力；右侧颈部疼痛；右半舌体萎缩和肌束震颤；右侧Homer综合征右侧转颈MRA、CTA右侧茎突截短术
2017/美国[9]60/男突发右侧耳后疼痛；双额部疼痛；左侧肢体无力伴感觉异常；一过性言语不清不明确CTA、DSA双侧抗凝+抗血小板聚集+颈动脉支架植入术
2019/中国[6]56/男左侧肢体麻木伴乏力；一过性言语不清低头时、转头时CTA、DSA、TCD右侧茎突截短术
2019/日本[10]49/男左侧肢体无力伴言语不清；颈部疼痛仰头伸颈动作MRA、CTA右侧抗凝1周+抗血小板聚集治疗3个月+健康教育
2021/格鲁吉亚[11]67/男发作性言语不清不明确CTA双侧茎突截短术；抗凝+抗血小板聚集治疗
2021/日本[12]27/男右侧肢体无力伴言语不清左侧转头时CTA、DSA、动态颈部血管超声左侧左侧茎突截短术
2021/中国*例174/男一过性左侧肢体力弱右侧曲颈CTA、动态TCD双侧止血、脱水降颅压+佩戴颈托+健康教育
2023/中国*例283/女发作性右眼视物不清伴左侧肢体力弱右侧转头或久蹲后低头CTA、动态TCD双侧抗血小板聚集+健康教育
2023/巴基斯坦[13]65/男双眼黑曚、晕厥；颈部疼痛左侧转颈时MRA、CTA、颈部血管超声双侧茎突截短术
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13例茎突-颈动脉综合征患者的临床资料

, figureFileSmall=null, figureFileBig=null, tableContent=
年度/国家文献年龄(岁)/性别临床表现诱发因素辅助检查位置治疗
2007/美国[2]77/男发作性右手麻木伴失语左侧转头、左下低头MRA、CTA左侧左侧茎突截短术
2012/美国[4]80/男头晕、晕厥转颈时CTA双侧双侧茎突截短术
57/男左侧颈部疼痛；头痛；一过性言语不清、右侧肢体瘫痪颈部按摩后MRA、CTA双侧抗凝+抗血小板聚集+颈动脉球囊扩张+颈动脉支架植入术
2014/美国[7]57/女发作性右侧肢体无力伴晕厥；左耳“嗖嗖”声右侧转颈、打哈欠CTA左侧左侧茎突截短术
2014/加拿大[8]56/女一过性左下面部感觉异常、一过性左下肢无力；右侧颈部疼痛；右半舌体萎缩和肌束震颤；右侧Homer综合征右侧转颈MRA、CTA右侧茎突截短术
2017/美国[9]60/男突发右侧耳后疼痛；双额部疼痛；左侧肢体无力伴感觉异常；一过性言语不清不明确CTA、DSA双侧抗凝+抗血小板聚集+颈动脉支架植入术
2019/中国[6]56/男左侧肢体麻木伴乏力；一过性言语不清低头时、转头时CTA、DSA、TCD右侧茎突截短术
2019/日本[10]49/男左侧肢体无力伴言语不清；颈部疼痛仰头伸颈动作MRA、CTA右侧抗凝1周+抗血小板聚集治疗3个月+健康教育
2021/格鲁吉亚[11]67/男发作性言语不清不明确CTA双侧茎突截短术；抗凝+抗血小板聚集治疗
2021/日本[12]27/男右侧肢体无力伴言语不清左侧转头时CTA、DSA、动态颈部血管超声左侧左侧茎突截短术
2021/中国*例174/男一过性左侧肢体力弱右侧曲颈CTA、动态TCD双侧止血、脱水降颅压+佩戴颈托+健康教育
2023/中国*例283/女发作性右眼视物不清伴左侧肢体力弱右侧转头或久蹲后低头CTA、动态TCD双侧抗血小板聚集+健康教育
2023/巴基斯坦[13]65/男双眼黑曚、晕厥；颈部疼痛左侧转颈时MRA、CTA、颈部血管超声双侧茎突截短术
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茎突-颈动脉综合征2例临床特征分析及文献复习
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高成恩 1 , 贾永林 1, * , 张保华 1 , 张宁 1 , 韩新生 1 , 代育萍 2
解放军医学杂志 | 临床研究 2024,49(10): 1156-1162
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解放军医学杂志 | 临床研究 2024, 49(10): 1156-1162
茎突-颈动脉综合征2例临床特征分析及文献复习
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高成恩1, 贾永林1, * , 张保华1, 张宁1, 韩新生1, 代育萍2
作者信息
  • 1开封市中心医院神经内科，河南开封 475000
  • 2南昌理工学院法学院，江西南昌 330044

    • 高成恩，医学硕士，主治医师，主要从事重症脑血管病、中枢神经系统感染性疾病方面的研究

通讯作者:

贾永林，E-mail：
Clinical characteristics of 2 cases of styloid-carotid artery syndrome and literature review
Cheng-En Gao1, Yong-Lin Jia1, * , Bao-Hua Zhang1, Ning Zhang1, Xin-Sheng Han1, Yu-Ping Dai2
Affiliations
  • 1Department of Neurology, Kaifeng Central Hospital, Kaifeng, Henan 475000, China
  • 2Law School of Nanchang Institute of Technology, Nanchang, Jiangxi 330044, China
出版时间: 2024-10-28 doi: 10.11855/j.issn.0577-7402.0044.2024.0506
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摘要
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目的 总结茎突-颈动脉综合征2例的临床特点并文献复习，以提高对该病的认识。方法 回顾性分析开封市中心医院神经内科收治的2例茎突-颈动脉综合征患者的临床表现、辅助检查及诊治经过，并通过PubMed、WOS、Embase、中国知网及维普等国内外数据库检索相关文献。综合文献结果，总结茎突-颈动脉综合征的临床特点。结果 2例经头颈CT血管成像(CTA)和茎突CT等检查确诊为短暂性脑缺血(TIA)合并茎突-颈动脉综合征。除本院收治的2例外，中英文文献共报道11例茎突-颈动脉综合征患者(截至2023年10月)。13例中，11例(84.6%)以发作性的TIA症状起病，11例(84.6%)有明显的特殊头位变化的诱发因素。该病常见临床表现为单侧肢体力弱伴或不伴感觉障碍(10例，76.9%)、言语不清(7例，53.8%)、单侧肢体感觉障碍(4例，30.7%)、晕厥(3例，23.1%)、黑曚(2例，15.4%)。13例均行64排头颈CTA检查，6例(46.2%)通过经颅多普勒超声(TCD)、颈部血管超声及数字减影血管造影(DSA)等检查动态观察了血流速度变化情况。所有患者均随访观察>3个月，10例(76.9%)经治疗后达临床治愈，其中8例行茎突截短术；3例(23.1%)经治疗后达临床症状缓解。结论 对于反复TIA或脑梗死发病患者，应了解有无特殊体位变换相关的诱发因素；对高度怀疑茎突-颈动脉综合征患者，应常规行茎突CT、64排头颈CTA检查，必要时行全脑DSA、动态TCD或颈部血管超声等检查，以指导诊治。非手术治疗效果不佳时，可考虑行茎突截短术治疗。

茎突-颈动脉综合征  /  茎突过长  /  卒中  /  动态超声  /  CT血管成像

Objective To summarize the clinical characteristics of 2 cases of styloid-carotid syndrome(SCS) and review the literature to enhance understanding of the disease. Methods A retrospective analysis was conducted on the clinical manifestations, auxiliary examinations, and diagnosis and treatment of 2 patients with SCS admitted to the Neurology Department of Kaifeng Central Hospital. Additionally, relevant literature was searched through domestic and foreign databases such as PubMed, WOS, Embase, CNKI and VIP. The clinical characteristics of SCS were summarized based on the literature results. Results The 2 cases were diagnosed as transient cerebral ischemia (TIA) combined with SCS through head and neck CT angiography (CTA) and styloid process CT. Apart from the 2 cases treated in our hospital, a total of 11 cases of SCS have been reported in Chinese and English literature up to October 2023. Among the 13 cases, 11 cases (84.6%) started with episodic TIA symptoms, and 11 cases (84.6%) had obvious inducing factors related to specific head position changes. Common clinical manifestations included unilateral limb weakness with or without sensory disturbance (10 cases, 76.9%), slurred speech (7 cases, 53.8%), unilateral limb sensation disorder (4 cases, 30.7%), syncope (3 cases, 23.1%) and amaurosis (2 cases, 15.4%). All 13 cases underwent 64-row head and neck CTA examination, and 6 cases (46.2%) dynamically observed the changes in blood flow velocity through examinations such as transcranial Doppler ultrasound (TCD), cervical vascular ultrasound, and digital subtraction angiography (DSA). All patients were followed up for more than 3 months; and 10 cases (76.9%) achieved clinical cure after treatment, of which 8 cases underwent styloid process shortening surgery; 3 cases (23.1%) achieved clinical symptom improvement after treatment. Conclusions For patients with recurrent TIA and/or cerebral infarction, it is necessary to identify whether there are inducing factors related to specific body position changes. For patients highly suspected of SCS, routine examinations such as styloid process CT and 64-row head and neck CTA should be performed, and if necessary, whole brain DSA, dynamic TCD and/or carotid ultrasound should be conducted to guide the diagnosis and treatment. When non-surgical treatment is ineffective, radical styloid process truncation can be considered as a treatment option.

styloid-carotid syndrome  /  elongated styloid process  /  stroke  /  dynamic ultrasonography  /  CT angiography
高成恩, 贾永林, 张保华, 张宁, 韩新生, 代育萍. 茎突-颈动脉综合征2例临床特征分析及文献复习. 解放军医学杂志, 2024 , 49 (10) : 1156 -1162 . DOI: 10.11855/j.issn.0577-7402.0044.2024.0506
Cheng-En Gao, Yong-Lin Jia, Bao-Hua Zhang, Ning Zhang, Xin-Sheng Han, Yu-Ping Dai. Clinical characteristics of 2 cases of styloid-carotid artery syndrome and literature review[J]. Medical Journal of Chinese People’s Liberation Army, 2024 , 49 (10) : 1156 -1162 . DOI: 10.11855/j.issn.0577-7402.0044.2024.0506
正文
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茎突综合征(styloid process syndrome)，又称茎突舌骨综合征(stylohyoid syndrome)，是由于茎突延长或茎突舌骨韧带和茎突下颌韧带骨化或钙化，压迫周围神经和血管等结构导致的一系列综合征；1937年由耳鼻咽喉科医师Eagle首先报道，故命名为Eagle综合征[1]。Eagle综合征可分为两种类型，即经典茎突舌骨综合征(classic stylohyoid syndrome)和茎突-颈动脉综合征(styloid-carotid syndrome)。Eagle综合征多发生于扁桃体切除术或其他咽部手术后，扁桃体窝可见包块，主要症状包括耳面部麻木疼痛、颈部疼痛、发音困难、吞咽痛、咽部异物感、舌体疼痛，唾液分泌增加、味觉改变、上肢疼痛等；这些症状在转头或伸舌时发生或加重，打哈欠时也可诱发或加重。上述症状都是颅神经中的三叉神经(Ⅴ)、面神经(Ⅶ)、舌咽神经(Ⅸ)或迷走神经(Ⅹ)受刺激的表现。茎突-颈动脉综合征发生于茎突接触或间接压迫颈内动脉或颈外动脉时，刺激与动脉伴行的交感神经丛，引起颈面部疼痛或头痛；直接压迫颈动脉引起狭窄，可造成颈动脉夹层、晕厥、眩晕、短暂性脑缺血发作(TIA)或脑梗死等疾病[2-3]。有学者认为，延长的茎突反复撞击颈部血管可导致颈内动脉粥样斑块形成、脱落或破裂，也是引起脑缺血的原因之一[2,4-5]。本研究回顾性分析开封市中心医院神经内科收治的2例茎突-颈动脉综合征，并结合文献回顾总结其临床特点，以期加强临床医师对此病的认识。
1 病例资料
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1.1 例1
1.1.1 病史
患者男，74岁，因“一过性左侧肢体力弱6 h，恶心呕吐5 h”于2021年7月3日入院。患者骑自行车时出现左侧肢体力弱，可抬举，但持物及站立均不稳，歪倒在地致左颞部外伤，症状持续约2 h缓解；恶心并呕吐非咖啡色胃内容物。15年前有类似病史，住院诊断为“短暂性脑缺血”(transient cerebral ischemia，TIA)发作，治疗后好转出院，但仍有间断发作，未再诊治；有“慢性阻塞性肺疾病、冠心病、右侧髋关节置换术后”病史。曾吸烟40年余(10支/d)，已戒20年，否认饮酒史。
1.1.2 入院时体检
血压右136/76 mmHg，左132/74 mmHg；左颞部可见一4 cm×4 cm皮下包块，心、肺、腹查体及神经系统专科查体未见异常。ABCD2评分5分。血尿常规等辅助检查无明显异常。
1.1.3 影像学及脑脊液检查
急诊头颅CT示颅内多发腔隙性脑梗死、缺血灶，颅盖骨未见骨折；老年性脑改变；左颞区皮下软组织肿胀。头MRI示颅内多发腔隙性脑梗死，弥散加权成像(DWI)未见新发急性脑梗死；双侧枕区少量蛛网膜下腔出血。MRI血管成像(MRA)提示动脉粥样硬化。超声心动图示左室射血分数(LVEF)58%，心内结构及血流未见异常。颈部血管多普勒超声提示右侧颈总动脉远段后壁可见12.7 mm×1.6 mm低回声不均质斑块，左侧颈总动脉远段后内壁可见10.4 mm×2.3 mm低回声不均质斑块；右侧颈内动脉起始段后壁可见5.8 mm×3.2 mm低回声不均质斑块；右侧锁骨下动脉起始段可见12.1 mm×3.2 mm高回声不均质斑块。发泡试验+栓子监测未见异常。经颅多普勒超声(TCD)提示右椎动脉颅内段、基底动脉血流速度增快。64排头颈CT血管成像(CTA)及茎突CT显示脑动脉粥样硬化并局限性狭窄；双侧茎突过长(右3.85 cm，左3.73 cm)，右侧茎突尖端距其内侧颈内动脉约0.27 cm(图1)。右下方曲颈位TCD提示右侧颈内动脉虹吸部监测到收缩期峰值血流速度(Vs)和平均血流速度(Vm)均明显下降(图2)。腰椎穿刺脑脊液检查示脑脊液压力100 mmH2O，外观红色、浑浊，潘氏试验阳性。
1.1.4 诊断与治疗
出院临床诊断：(1)TIA(右侧颈内动脉)；(2)茎突-颈动脉综合征；(3)双侧枕区蛛网膜下腔出血(外伤性)；(4)慢性阻塞性肺疾病；(5)冠心病，心肌缺血，心功能2级。
住院期间给予止血、脱水降颅压、脑保护等治疗，同时给予健康宣教，建议佩戴颈托，避免右下转颈等治疗2周。患者病情好转出院。
1.1.5 随访
出院后1个月，患者因“外伤后迟发性硬膜下血肿”外科手术治疗后好转出院，继续随访患者病情变化，必要时行右侧茎突截短术。随诊2年内上述症状仍有间断发作(骨折1次)，经生活方式干预后，TIA发作频次明显降低，远期疗效有待长期随访观察。
1.2 例2
1.2.1 病史
患者女，83岁，因“发作性右眼视物不清伴左侧肢体力弱3个月，再发3 d”于2023年4月24日入院。急性起病，休息时(蹲位)出现右眼视物不清，伴左侧肢体力弱，走路不稳，症状持续30 s至1 min，可完全缓解，约半个月出现一次。后上述症状再发，就诊于神经内科门诊，行头部MRI检查提示颅内多发脑梗死；颈部血管超声提示颈动脉粥样硬化并斑块形成，未特殊治疗；自觉上述症状加重3 d，最多每天发作5次，每次发作多于右侧转头或久蹲后低头出现，遂住院诊治。高血压病史2年，未口服药物，平时150/80 mmHg左右。
1.2.2 入院时体检
血压右162/90 mmHg、 左166/81 mmHg。神经科查体无明显异常。ABCD2评分5分。空腹血糖6.82 mmol/L，糖化血红蛋白7.0%，进一步行糖耐量试验确诊2型糖尿病，建议其糖尿病饮食，监测血糖指导治疗。
1.2.3 影像学及其他检查
头部MRI示颅内多发腔隙性脑梗死，DWI未见新发急性脑梗死，老年性脑改变，脑动脉硬化。超声心动图示LVEF 62%，左心房扩大。颈部及双下肢血管超声提示动脉粥样硬化并粥样硬化斑块形成(双侧颈总动脉、右侧颈内动脉及双下肢动脉可见低回声不均质斑块)。TCD提示双侧椎动脉颅内段、基底动脉血流速度偏快。视觉电生理检查(VEP)示右侧视觉传导通路功能障碍。64排头颈CTA及茎突CT：脑动脉粥样硬化并局限性狭窄；双侧茎突过长(右4.39 cm，左3.25 cm)，右侧茎突尖端距其内侧颈内动脉约0.22 cm，距外侧颈外动脉约0.12 cm(图3)。右侧屈颈位TCD提示右侧颈内动脉虹吸部监测到Vs和Vm均明显下降(图4)。
1.2.4 诊断与治疗
出院临床诊断：(1)TIA(右侧颈内动脉)；(2)茎突-颈动脉综合征；(3)高血压病2级，极高危；(4)2型糖尿病。
入院后因患者TIA发作频繁，不能排除心源性栓塞可能，给予低分子肝素抗凝联合氯吡格雷抗血小板聚集、调脂及脑保护等治疗，72 h持续心电监测、超声心动图、发泡试验及微栓子检测结果示基本排除心源性栓塞病因。详细询问患者病史，其每次发作多于右侧转头或久蹲后低头时出现，结合头部MRI、头颈CTA及动态TCD等后续检查，其病理生理学机制考虑血流动力异常所致。给予调整治疗方案为阿司匹林联合氯吡格雷抗血小板聚集、调脂及脑保护等治疗，同时给予健康宣教，避免右侧转颈及久蹲时低头等治疗10 d，患者TIA发作频率明显降低，病情好转出院。
1.2.5 随访
出院后1、3及6个月复诊，上述症状6个月内仅发作1次；继续随访。
2 文献检索与复习
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以关键词“茎突综合征、茎突过长、卒中、动态超声、CTA、外科手术”分别在PubMed、WOS、Embase、中国知网及维普等国内外数据库进行文献检索，截至2023年10月，共检索出符合条件的中文文献1篇[6]，英文文献9篇[2,4,7-13]；获取全文后经分析，共纳入13例茎突-颈动脉综合征患者(包括本院收治的2例)。
13例中，男10例，女3例(男女比3.3:1)。发病年龄(62.2±15)岁。11例(84.6%)以发作性TIA症状起病，11例(84.6%)有明显的头位变化诱发因素。临床表现有单侧肢体力弱伴/不伴感觉障碍(10例，76.9%)、言语不清(7例，53.8%)、单侧肢体感觉障碍(4例，30.7%)、晕厥(3例，23.1%)、黑曚(2例，15.4%)等。13例(100.0%)均行头颈CTA检查，6例(46.2%)通过TCD、颈部血管超声及数字减影血管造影(DSA)观察到血流速度变化。13例均经≥3个月的随访观察，10例(76.9%)经治疗后达临床治愈，其中8例行茎突截短术；3例(23.1%)经治疗后临床症状缓解(表1)。
3 讨论
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茎突是颞骨在颅底面向下伸出的一个细长的圆锥状的骨性突起，其起源于颞骨下面茎乳孔的前方，呈细圆柱状，远端伸向内前下方，位于颈内动脉与颈外动脉之间[14]；或其远端伸向外下，靠近下颌骨的内侧；偶尔可向后达颈椎前方。典型茎突是直的，但也可呈弯曲状。茎突根部自上而下有3块肌肉(茎突舌肌、茎突咽肌和茎突舌骨肌)和2条韧带(茎突舌骨韧带和茎突下颌韧带)附着，同时有4条颅神经(面神经、舌咽神经、迷走神经和舌下神经)分布在其周围(图5)。一般认为，正常茎突长度为2.0~3.0 cm，>3.0 cm被认为是茎突过长[1]。茎突过长可引起不同类型的Eagle综合征。但对于茎突-颈动脉综合征，茎突过长不是必要的。Tubbs等[3]的20例(40侧)成人尸体解剖结果显示，5例(12.5%)的颈内动脉被邻近的茎突咽肌压迫，且造成颈内动脉管腔狭窄30%~50%，当头向同侧旋转时，可使狭窄程度进一步增加25%。故有学者推测茎突长度正常的情况也可压迫或撞击颈部动脉，这可能与茎突角度异常(向内侧或外侧偏斜)或颈内动脉本身的解剖学变化有关。特别是当患者头部处于特定位置时，可导致茎突撞击颈内动脉，压迫不同神经、肌肉和血管，引起多种临床症状。
茎突-颈动脉综合征是Eagle综合征的一个特殊类型，临床发病率低。2019年，董佳等[6]报道了1例茎突-颈动脉综合征，但未见我国学者对其发病率及相关临床特征的报道。本研究显示，该病男性多于女性，男女比3.3:1.0，发病平均年龄62岁。其发生发展多有“转颈、低头、头部仰伸、颈部按摩”等体位变换的诱发因素，临床表现多为单侧肢体力弱/感觉异常、言语不清、黑矇、晕厥等症状，呈发作性、刻板性特点。结合国内外文献报道，推测其发病机制主要包括：(1)茎突刺激颈部动脉伴行交感丛引起疼痛；(2)机械压迫引起动脉狭窄；(3)机械刺激或撞击损伤动脉壁导致血栓栓塞或颈动脉夹层；(4)撞击导致颈内动脉粥样斑块形成、脱落或破裂等[4-5]。
研究显示，该病临床知晓率低，个别病例症状不典型，易发生误诊，致部分患者反复发作，甚至出现严重的内外科疾病，如大面积脑梗死、颈动脉夹层、颈动脉支架断裂等不良后果，亦可间接引发外伤性硬膜下出血、骨折等严重疾患[4-5]。究其原因，该病多以TIA作为主要诊断而就诊，加之中老年患者常合并高血压病、糖尿病、高脂血症等基础疾病，致临床医师易认为其病因为“动脉粥样硬化”，而忽略“茎突过长”这一病因。2014年Bensoussan等[8]报道了1例以“右侧舌下神经麻痹和右侧Horner综合征”起病的不典型茎突-颈动脉综合征。2020年Wacławek等[15]报道该病从出现症状到明确诊断的平均时间约为5年，患者多就诊于耳鼻喉科、口腔科及神经科等。因此，临床对于首发症状不典型的病例，更需要仔细询问病史及动态监测病情变化，提高对茎突-颈动脉综合征的警惕性。
例1和例2均存在双侧茎突过长，右侧茎突过长，均为其发病病因，通过“右下方向曲颈(例1)、右侧曲颈(例2)”的特殊体位，监测患者TCD，均在右侧颈内动脉虹吸部监测到Vs和Vm明显下降，均清楚地显示颈部特殊位置下颈动脉血流延迟，间接提示患者颈部动脉受压。常规的茎突CT及64排头颈部CTA检查是必要的，64排头颈部CTA及全脑DSA检查可清楚地显示血管与周围组织间的毗邻关系，对于了解茎突及其与周围血管结构的关系至关重要，可为临床诊断提供客观依据[2,9,14]。对于难以实施全脑DSA检查的患者，特殊体位下TCD或颈部血管超声检查可间接提示颈部动脉受压[14]，为临床诊断提供依据。但对于症状发作频繁、病情危重的患者，特殊体位下TCD或颈部血管超声检查需慎重，可能导致患者病情进展或加重[2]。有研究指出Eagle综合征的发病率与茎突长度或身体侧面之间无明显相关性，且该病虽然双侧发生，但患者症状大多是单侧的，可能存在隐匿致病因素[12]。本研究显示该病的发生多存在“特殊体位”诱发，推测“茎突倾斜角度”可能与临床症状密切相关，其与Eagle综合征发病的相关性尚待进一步的大样本研究确认。
茎突-颈动脉综合征的治疗需个体化，目前学者推荐的确切治疗方法是茎突截短术。但对于非茎突过长、合并多种内外科疾病及不能耐受手术者，个体化的抗凝和(或)抗血小板聚集、调脂、合理的健康教育及生活方式干预对于预防疾病复发仍很重要[11]。本研究长期随访结果显示，该病经积极治疗，临床治愈率较高；国外研究也显示该病预后相对良好[12]。
本研究存在以下不足：(1)单中心研究，样本量小，未来有条件可开展多中心研究；(2)仅在特殊头位下通过TCD监测了颈内动脉虹吸部血流变化情况，未在全脑血管造影下动态监测颈动脉狭窄变化情况，缺乏更精准的评估手段；(3)该病患者以老年人居多，是否存在“发病年龄延迟”尚不明确；(4)该病是否存在隐匿性早发病因和(或)诱因亦不明确。因此，今后临床工作中应重视对反复TIA和(或)脑梗死发病患者的病因筛查，详细询问病史，了解有无特殊体位变换的诱发因素，对高度怀疑茎突-颈动脉综合征患者，建议行茎突CT、头颈部CTA等常规检查，必要时行全脑DSA、动态TCD和(或)颈部血管超声等检查以指导诊治，以减少误诊。非手术治疗效果不佳时，可考虑行茎突截短术治疗。
基金
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  • 河南省医学科技攻关计划项目(LHGJ20230793)
  • 开封市科技发展计划项目(2203060)
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参考文献 引证文献
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Keshelava G, Kurdadze R, Tsiklauri D. Surgical management of a patient with an internal carotid artery stenosis, Eagle syndrome, and internal carotid artery tortuosity: a case of four pathologies of the carotid arteries[J]. EJVES Vasc Forum, 2021, 50: 37-39.
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Tanaka Y, Anami H, Kurihara H, et al. Eagle syndrome with hidden stylocarotid syndrome examined using dynamic ultrasonography: illustrative case[J]. J Neurosurg Case Lessons, 2021, 1(26): CASE21286.
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Amir MA, Rehman IU, Riaz U, et al. Battling the Eagle's sharp beak, Eagle syndrome; a case report[J]. eNeurologicalSci, 2023, 31: 100462.
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Badhey A, Jategaonkar A, Anglin Kovacs AJ, et al. Eagle syndrome: a comprehensive review[J]. Clin Neurol Neurosurg, 2017, 159: 34-38.
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2024年第49卷第10期
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doi: 10.11855/j.issn.0577-7402.0044.2024.0506
  • 接收时间：2024-01-11
  • 首发时间：2025-11-20
  • 出版时间：2024-10-28
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  • 收稿日期：2024-01-11
  • 录用日期：2024-01-30
基金
Medical Science and Technology Project of Henan Province(LHGJ20230793)
河南省医学科技攻关计划项目(LHGJ20230793)
Science and Technology Development Project of Kaifeng(2203060)
开封市科技发展计划项目(2203060)
作者信息
    1开封市中心医院神经内科，河南开封 475000
    2南昌理工学院法学院，江西南昌 330044

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2种不同金属材料的力学参数
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Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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