Cerebral infarction caused by coexisting elongated styloid process and carotid web

Objective: Elongated styloid process (ESP) and carotid web are rare etiologies of ischemic stroke. We report a rare case of ESP concomitant with carotid web as the cause of recurrent stroke. Case presentation: A 59-year-old man was admitted to our hospital with recurrent numbness and weakness in the right upper extremity. The patient had a long-standing history of lightheadedness and left-side amaurosis with neck flexion. Magnetic resonance imaging (MRI) confirmed scattered infarctions in the left frontal and parietal lobes. After multi-modal imaging we determined that embolic cerebral infarction was most likely to be secondary to the carotid web. Moreover, ESP causes dynamic hypoperfusion during neck flexion. We believe that this is a good reason for dealing with both pathologies during the same surgery. Thus, carotid endarterectomy and styloid process resection were performed at the same time. The previous symptoms during the head position change did not recur, and the right hand weakness was resolved. Conclusion: ESP and carotid web are unusual mechanisms of ischemic stroke. Early diagnosis and timely treatment are essential to prevent subsequent severe strokes.