“Winged” Eagle’s syndrome: neurophysiological findings in a rare cause of spinal accessory nerve palsy. Illustrative cases

Eric C. Mitchell, Kitty Y. Wu, Fawaz Siddiqi, John Yoo, Pavlo Ohorodnyk, Douglas Ross, Thomas A. Miller

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND Eagle’s syndrome (ES) classically describes dysphagia, globus sensation, and otalgia from an elongated and calcified styloid process or stylohyoid ligament. Compression of the spinal accessory nerve (SAN) has not been reported as an associated feature of ES or related variants. OBSERVATIONS The authors describe two cases of an atypical “winged” variant with SAN palsy resulting from compression by a posteriorly angulated or calcified styloid process. Both patients exhibited lateral scapular winging and atrophy of the trapezius and sternocleidomastoid muscles. Electrophysiological studies demonstrated motor unit preservation; therefore, surgical exploration, styloidectomy, and SAN decompression were performed through a transcervical approach. Postoperatively, both patients had improvements in pain and shoulder mobility, the return of muscle strength, and electrophysiological evidence of trapezius reinnervation. LESSONS Compression of the SAN, which can be identified both clinically and on electrodiagnostic testing, is an atypical finding that can result from a posteriorly angulated or calcified styloid process. This winged variant of ES should be included in the differential for SAN palsy, and a multidisciplinary approach is recommended for assessment and management.

Original languageEnglish
Article numberCASE23358
JournalJournal of Neurosurgery: Case Lessons
Volume6
Issue number24
DOIs
StatePublished - Dec 2023
Externally publishedYes

Keywords

  • Eagle’s syndrome
  • scapular winging
  • spinal accessory nerve compression
  • styloid process
  • trapezius

Fingerprint

Dive into the research topics of '“Winged” Eagle’s syndrome: neurophysiological findings in a rare cause of spinal accessory nerve palsy. Illustrative cases'. Together they form a unique fingerprint.

Cite this