Clipping the Eagle's wings: treatment of an unusual cause of transient cerebral ischemia.

Transient monocular blindness (TMB) associated with hemispheric TIA is indicative of internal carotid artery (ICA) occlusive disease and an increased risk for stroke.1 However, not all cases of TMB or TIAs reflect intraluminal ICA pathology. We present a patient who had recurrent, stereotypical TMB and hemispheric TIAs from an elongated styloid process compressing the extracranial portion of the ICA, leading to intermittently decreased cerebral blood flow. A previously healthy 38-year-old right-handed woman was examined for a 14-month history of recurrent spells, consisting of sudden left eye “graying out,” followed by right arm, then right leg heaviness and “shaking,” dysarthria, and a feeling of fainting. Symptoms occurred once or twice every 2 to 3 months initially, increasing to three per month. Episodes lasted up to 1 minute and resolved in reverse order. Left head rotation while reaching with her arms was identified as a trigger. Four-vessel cerebral angiography …