耳鼻咽喉科臨床
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
臨床
浮動性めまいを伴った茎状突起過長症例
堀 秀成林 一樹宮崎 拓也市丸 和之
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2022 年 115 巻 7 号 p. 625-629

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Elongated styloid processes could be associated with a variety of symptoms, which have been described in detail by W. Eagle.

We present the case of a patient with styloid process syndrome who presented with dizziness. A 42-year-old woman was referred to our hospital with a 4-year history of pharyngeal pain, tinnitus and dizziness during cervical rotation. Although she had been suffering the symptoms for four years, no diagnosis had been made and she was not under clinical follow-up. Her condition became steadily worse.

3D-CT showed bilateral elongated styloid processes compressing the internal jugular vein medially at the level of the first to second cervical vertebra.

Elongated styloid processes cause compression of the internal jugular vein during changes of the head position. Compression of the internal jugular vein causes decrease of the cardiac output and decrease of the cerebral blood flow. It was predicted that the cause of dizziness in these patients is circulatory disturbance, when Nagayama and others reported cases in which dizziness was accompanied by a decrease of the brain blood flow. They described both cases with reduced blood flow in the vertebral artery and those with reduced blood flow in the internal carotid artery. When the blood supply decreases in the vertebral artery, it also decreases in the vertebrobasilar artery, and reduction of blood flow in the vertebrobasilar arteries causes dizziness and disturbance of consciousness as the major symptoms, with nystagmus induced by neck rotation. On the other hand, it is said that impaired carotid artery blood flow mainly causes disturbance of consciousness as the major symptom, and rarely produces dizziness. However, it has been reported that dizziness can occur when the overall cerebral blood flow decreases with decrease in the blood flow to the brainstem.

The patient underwent surgical treatment via the transcervical approach. Postoperative 3D-CT showed that the lengths of the residual styloid processes were within normal range (within 30 mm), and the subjective symptoms of the patient, including dizziness, improved.

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