A 56-year-old man with type 2 diabetes presented to the emergency department with an acute onset of weakness in the left arm and tongue paresthesia that lasted about 5 minutes. The symptoms had recurred several times on the way to the hospital. On assessment, the patient’s vital signs and neurologic examination were normal, and the initial working diagnosis was a transient ischemic attack. Computed tomography with contrast showed normal cerebrovasculature, without extracranial dissection or aneurysm; however, both styloid processes were elongated, and his right internal carotid artery was compressed between the right styloid process and the C1 transverse process (Figure 1A; Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.202803/tab-related-content). The imaging and clinical presentation were consistent with Eagle syndrome, and we were consulted for urgent surgical management.
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