Cervical Neuralgia Revealing Eagles Syndrome about a Presentation

Healthy 8-year-old man with a history of neck pain with irradiation to the right acromial level progressive for 15 days. The neurological manifestations began with progressive paraesthesia of the upper limbs of proximal location evolving towards the cervical part. In addition, he reported a new transient generalized band-shaped headache and slight dizziness. The medical history was unremarkable except for hypertension.

General physical examination

Good general condition, good coloring of the mucous membranes, good state of hydration.

Vital parameters

Body temperature of 36.5°C, blood pressure of 105/75 mm Hg, respiratory rate of 16 bpm, pulse of 65 beats/min and oxygen saturation of 99%.

Neurological examination

Motor examination revealed normal tone and strength compared to the Medical Research Council score. The osteotendinous reflexes were unremarkable. Sensory examination unremarkable. The remainder of the examination was unremarkable. All conventional diagnostic tests were essentially normal, including EKG, routine blood chemistry, protein C-. Some additional examinations were carried out, notably electro neuromyography and cervical imaging.

Electromyography showed reduced recruitment to the right deltoid muscles. The findings were consistent with right c5 radiculopathy. A medication consisting of non-steroidal anti-inflammatory and analgesic with relief of pain and an opinion requested from an ENT specialist (Figure 1).

Anatomically, the styloid process arises from the temporal bone and passes downward, forward, and medially. Embryologically, it is derived from Reichert’s cartilaginous component of the second branchial arch. Ossification of the styloid process and the Stylohyoid ligament results in an increase in the thickness and length of the Styloid process, which then presses on adjacent structures such as the internal jugular vein, carotid artery, facial nerve, nerve vagus, the glossopharyngeal nerve and the hypoglossal nerve. , leading to various pressure symptoms [5].The styloid process is normally 2.5 to 3 cm long; when the length exceeds 3 cm, it is said to be elongated [6-7].

The etiopathogenetic mechanism of elongation of the styloid process has not been established until now; developmental abnormalities and/or alterations in bone homeostasis have been proposed to explain the occurrence of ossification or elongation of the stylohyoid process [8]. Symptoms of classic Eagle syndrome have been primarily associated with Intermittent compressive neuropathy involving different branches of the cranial nerves, which is often exacerbated by swallowing and yawning [9].

These symptoms are caused by a mass effect on the cranial nerves causing neuropathy pain that responds poorly to medications as is the case with our patient. Patients with vague symptoms of head and neck pain may lead to a broad differential diagnosis [5-11].

Medical history is the primary guide for the diagnosis of Eagle syndrome. The patient’s description of symptoms is very important. Next, it is necessary to do a local examination by palpating the tonsillar fossa, which should reveal bone formation and should exacerbate the pain aggravating the symptoms with local tenderness. Usually, patients have temporary relief of symptoms from local lidocaine infiltration. The radiological examination confirms the diagnosis: an orthopantomography and a CT scan are necessary [12-15]. Many factors can determine changes in the structure of the styloid process and its shape, position and size can vary [16].

A wide variety of symptoms have been attributed to elongation of the styloid process [1]. The use of computed tomography is indicated for diagnosis, although an accurate history, local examination and orthopantomography are also necessary [15]. Nowadays, literature tends to support that surgical treatment results in a more definitive and lasting symptomatic relief [10-17].

Eagles’ syndrome is a pathology characterized by an abnormal elongation of the styloid process, the latter of which slightly irritates the cervical structure and is responsible for either neck pain or other symptoms.

Symptomatic and disappointing treatment and curative treatment is based on surgery.

None.

Conflict of Interest

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