{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:03:03Z","timestamp":1787025783069,"version":"build-2736575974"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"24","license":[{"start":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T00:00:00Z","timestamp":1702252800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Eagle\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors describe two cases of an atypical \u201cwinged\u201d 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23358","type":"journal-article","created":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T19:30:29Z","timestamp":1702323029000},"source":"Crossref","is-referenced-by-count":3,"title":["\u201cWinged\u201d Eagle\u2019s syndrome: neurophysiological findings in a rare cause of spinal accessory nerve palsy. Illustrative cases"],"prefix":"10.3171","volume":"6","author":[{"given":"Eric C","family":"Mitchell","sequence":"first","affiliation":[{"name":"Departments of Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kitty Y","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fawaz","family":"Siddiqi","sequence":"additional","affiliation":[{"name":"Departments of Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Yoo","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2014Head and Neck Surgery"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavlo","family":"Ohorodnyk","sequence":"additional","affiliation":[{"name":"Medical Imaging, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Ross","sequence":"additional","affiliation":[{"name":"Departments of Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A","family":"Miller","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Can J Neurol Sci","first-page":"337","article-title":"Accessory nerve palsy: a review of 23 cases","volume":"18","author":"Berry H","year":"1991","unstructured":"Berry H, MacDonald EA, Mrazek AC. Accessory nerve palsy: a review of 23 cases. Can J Neurol Sci. 1991;18(3):337\u2013341."},{"issue":"5","key":"b2","series-title":"Orthop Traumatol Surg Res","first-page":"589","article-title":"Idiopathic spinal accessory nerve palsy. A case report","volume":"96","author":"Sergides NN","year":"2010","unstructured":"Sergides NN, Nikolopoulos DD, Polyzois IG. Idiopathic spinal accessory nerve palsy. A case report. Orthop Traumatol Surg Res. 2010;96(5):589\u2013592."},{"issue":"5","key":"b3","series-title":"Arch Otolaryngol","first-page":"630","article-title":"Elongated styloid process: further observations and a new syndrome","volume":"47","author":"Eagle WW","year":"1948","unstructured":"Eagle WW, Elongated styloid process: further observations and a new syndrome. Arch Otolaryngol. 1948;47(5):630\u2013592."},{"issue":"4","key":"b4","series-title":"J Back Musculoskeletal Rehabil","first-page":"899","article-title":"Spinal accessory nerve injury: a potentially missed cause of a painful, droopy shoulder","volume":"29","author":"Macaluso S","year":"2016","unstructured":"Macaluso S, Ross DC, Doherty TJ, Doherty CDMT, Miller TA. Spinal accessory nerve injury: a potentially missed cause of a painful, droopy shoulder. J Back Musculoskeletal Rehabil. 2016;29(4):899\u2013904."},{"issue":"4","key":"b5","series-title":"Clin Anat","first-page":"487","article-title":"The importance of medial-lateral styloid process angulation\/coronal plane angle in symptomatic eagle syndrome","volume":"30","author":"Burulday V","year":"2017","unstructured":"Burulday V, Akg\u00fcl MH, Bayar Muluk N, Ya\u011fdiran B, Inal M. The importance of medial-lateral styloid process angulation\/coronal plane angle in symptomatic eagle syndrome. Clin Anat. 2017;30(4):487\u2013491."},{"key":"b6","series-title":"Eur Radiol","first-page":"693","article-title":"Muscle MRI findings in fascioscapulohumeral muscular dystrophy","volume":"26","author":"Gerevini S","year":"2016","unstructured":"Gerevini S, Scarlato M, Maggi L,  Muscle MRI findings in fascioscapulohumeral muscular dystrophy. Eur Radiol. 2016;26:693\u2013705."},{"issue":"1","key":"b7","series-title":"Arch Phys Med Rehabil","first-page":"23","article-title":"Accessory nerve latency to the middle and lower trapezius","volume":"66","author":"Green RFBM","year":"1985","unstructured":"Green RFBM, Brien M. Accessory nerve latency to the middle and lower trapezius. Arch Phys Med Rehabil. 1985;66(1):23\u201324."},{"issue":"1","key":"b8","series-title":"RMD Open","first-page":"e000472","article-title":"Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next","volume":"3","author":"Mader R","year":"2017","unstructured":"Mader R, Verlaan JJ, Eshed I,  Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next. RMD Open. 2017;3(1):e000472."},{"issue":"1","key":"b9","series-title":"BMC Neurol","first-page":"333","article-title":"The Eagle jugular syndrome","volume":"19","author":"Zamboni P","year":"2019","unstructured":"Zamboni P, Scerrati A, Menegatti E,  The Eagle jugular syndrome. BMC Neurol. 2019;19(1):333."},{"issue":"2","key":"b10","series-title":"Diagnostics (Basel)","first-page":"298","article-title":"Styloid jugular nutcracker: the possible role of the styloid process spatial orientation\u2014a preliminary morphometric computed study","volume":"13","author":"Mantovani G","year":"2023","unstructured":"Mantovani G, Zangrossi P, Flacco ME,  Styloid jugular nutcracker: the possible role of the styloid process spatial orientation\u2014a preliminary morphometric computed study. Diagnostics (Basel). 2023;13(2):298."},{"issue":"3","key":"b11","series-title":"Neurosurgery","first-page":"E795","article-title":"Styloidogenic jugular venous compression syndrome: diagnosis and treatment: case report","volume":"70","author":"Dashti SR","year":"2012","unstructured":"Dashti SR, Nakaji P, Hu YC,  Styloidogenic jugular venous compression syndrome: diagnosis and treatment: case report. Neurosurgery. 2012;70(3):E795\u2013E799."},{"key":"b12","series-title":"Ann Vasc Surg","first-page":"271.e15","article-title":"Bilateral Eagle syndrome with associated internal carotid artery kinking and significant stenosis","volume":"34","author":"Radak D","year":"2016","unstructured":"Radak D, Tanaskovic S, Kecmanovic V, Babic S, Popov P, Gajin P. Bilateral Eagle syndrome with associated internal carotid artery kinking and significant stenosis. Ann Vasc Surg. 2016;34:271.e15\u2013271.e18."},{"key":"b13","series-title":"Neurology2","first-page":"P7.023","article-title":"Rare presentation of Eagle\u2019s syndrome as Bell\u2019s palsy","volume":"82","author":"Rosales N","unstructured":"Rosales N, Gandhi R LR. Rare presentation of Eagle\u2019s syndrome as Bell\u2019s palsy. Neurology2. 14AD;82(10 suppl):P7.023."},{"issue":"2","key":"b14","series-title":"J Med Soc","first-page":"117","article-title":"Eagle syndrome with multiple cranial nerve involvement","volume":"228","author":"Bedajit RK","year":"2014","unstructured":"Bedajit RK, Priyokumar O, Abhilash RKS. Eagle syndrome with multiple cranial nerve involvement. J Med Soc. 2014;228(2):117\u2013119."},{"issue":"11","key":"b15","series-title":"Head Neck","first-page":"E153","article-title":"Styloid\/C1 transverse process juxtaposition as a cause of Eagle\u2019s syndrome","volume":"37","author":"Ho S","year":"2015","unstructured":"Ho S, Luginbuhl A, Finden S, Curry JM, Cognetti DM. Styloid\/C1 transverse process juxtaposition as a cause of Eagle\u2019s syndrome. Head Neck. 2015;37(11):E153\u2013E156."},{"issue":"1","key":"b16","series-title":"Craniomandib Sleep Pract","first-page":"56","article-title":"Eagle\u2019s syndrome: signs and symptoms","volume":"31","author":"Costantinides F","year":"2013","unstructured":"Costantinides F, Vidoni G, Bodin C, Di Lenarda R. Eagle\u2019s syndrome: signs and symptoms. Craniomandib Sleep Pract. 2013;31(1):56\u201360."},{"issue":"5","key":"b17","series-title":"Clin Anat","first-page":"545","article-title":"Eagle\u2019s syndrome: a review of the literature","volume":"22","author":"Piagkou M","year":"2009","unstructured":"Piagkou M, Anagnostopoulou S, Kouladouros K, Piagkos G. Eagle\u2019s syndrome: a review of the literature. Clin Anat. 2009;22(5):545\u2013558."},{"issue":"7","key":"b18","series-title":"Muscle Nerve","first-page":"858","article-title":"The effect of duration of muscle denervation on functional recovery in the rat model","volume":"20","author":"Kobayashi J","year":"1998","unstructured":"Kobayashi J, Mackinnon SE, Watanabe O, Ball DJ, Gu XM, Hunter DA. The effect of duration of muscle denervation on functional recovery in the rat model. Muscle Nerve. 1998;20(7):858\u2013866."},{"issue":"6","key":"b19","series-title":"Curr Opin Neurol","first-page":"718","article-title":"Traumatic peripheral nerve injuries: diagnosis and management","volume":"35","author":"Barnes SL","year":"2022","unstructured":"Barnes SL, Miller TA, Simon NG. Traumatic peripheral nerve injuries: diagnosis and management. Curr Opin Neurol. 2022;35(6):718\u2013727."},{"issue":"1","key":"b20","series-title":"Plast Reconstr Surg","first-page":"212","article-title":"The effect of two episodes of denervation and reinnervation on skeletal muscle contractile function","volume":"109","author":"Yoshimura K","year":"2002","unstructured":"Yoshimura K, Asato H, Jejurikar SS, Cederna PS, Urbanchek MG, Kuzon WM Jr. The effect of two episodes of denervation and reinnervation on skeletal muscle contractile function. Plast Reconstr Surg. 2002;109(1):212\u2013219."},{"issue":"2","key":"b21","series-title":"Muscle Nerve","first-page":"215","article-title":"Diagnosis of unilateral trapezius muscle palsy: 54 cases","volume":"56","author":"Seror P","year":"2017","unstructured":"Seror P, Stojkovic T, Lefevre-Colau MM, Lenglet T. Diagnosis of unilateral trapezius muscle palsy: 54 cases. Muscle Nerve. 2017;56(2):215\u2013223."},{"issue":"3","key":"b1","series-title":"Can J Neurol Sci","first-page":"337","article-title":"Accessory nerve palsy: a review of 23 cases","volume":"18","author":"Berry H","year":"1991","unstructured":"Berry H, MacDonald EA, Mrazek AC. Accessory nerve palsy: a review of 23 cases. Can J Neurol Sci. 1991;18(3):337\u2013341."},{"issue":"5","key":"b2","series-title":"Orthop Traumatol Surg Res","first-page":"589","article-title":"Idiopathic spinal accessory nerve palsy. A case report","volume":"96","author":"Sergides NN","year":"2010","unstructured":"Sergides NN, Nikolopoulos DD, Polyzois IG. Idiopathic spinal accessory nerve palsy. A case report. Orthop Traumatol Surg Res. 2010;96(5):589\u2013592."},{"issue":"5","key":"b3","series-title":"Arch Otolaryngol","first-page":"630","article-title":"Elongated styloid process: further observations and a new syndrome","volume":"47","author":"Eagle WW","year":"1948","unstructured":"Eagle WW, Elongated styloid process: further observations and a new syndrome. Arch Otolaryngol. 1948;47(5):630\u2013592."},{"issue":"4","key":"b4","series-title":"J Back Musculoskeletal Rehabil","first-page":"899","article-title":"Spinal accessory nerve injury: a potentially missed cause of a painful, droopy shoulder","volume":"29","author":"Macaluso S","year":"2016","unstructured":"Macaluso S, Ross DC, Doherty TJ, Doherty CDMT, Miller TA. Spinal accessory nerve injury: a potentially missed cause of a painful, droopy shoulder. J Back Musculoskeletal Rehabil. 2016;29(4):899\u2013904."},{"issue":"4","key":"b5","series-title":"Clin Anat","first-page":"487","article-title":"The importance of medial-lateral styloid process angulation\/coronal plane angle in symptomatic eagle syndrome","volume":"30","author":"Burulday V","year":"2017","unstructured":"Burulday V, Akg\u00fcl MH, Bayar Muluk N, Ya\u011fdiran B, Inal M. The importance of medial-lateral styloid process angulation\/coronal plane angle in symptomatic eagle syndrome. Clin Anat. 2017;30(4):487\u2013491."},{"key":"b6","series-title":"Eur Radiol","first-page":"693","article-title":"Muscle MRI findings in fascioscapulohumeral muscular dystrophy","volume":"26","author":"Gerevini S","year":"2016","unstructured":"Gerevini S, Scarlato M, Maggi L,  Muscle MRI findings in fascioscapulohumeral muscular dystrophy. Eur Radiol. 2016;26:693\u2013705."},{"issue":"1","key":"b7","series-title":"Arch Phys Med Rehabil","first-page":"23","article-title":"Accessory nerve latency to the middle and lower trapezius","volume":"66","author":"Green RFBM","year":"1985","unstructured":"Green RFBM, Brien M. Accessory nerve latency to the middle and lower trapezius. Arch Phys Med Rehabil. 1985;66(1):23\u201324."},{"issue":"1","key":"b8","series-title":"RMD Open","first-page":"e000472","article-title":"Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next","volume":"3","author":"Mader R","year":"2017","unstructured":"Mader R, Verlaan JJ, Eshed I,  Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next. RMD Open. 2017;3(1):e000472."},{"issue":"1","key":"b9","series-title":"BMC Neurol","first-page":"333","article-title":"The Eagle jugular syndrome","volume":"19","author":"Zamboni P","year":"2019","unstructured":"Zamboni P, Scerrati A, Menegatti E,  The Eagle jugular syndrome. BMC Neurol. 2019;19(1):333."},{"issue":"2","key":"b10","series-title":"Diagnostics (Basel)","first-page":"298","article-title":"Styloid jugular nutcracker: the possible role of the styloid process spatial orientation\u2014a preliminary morphometric computed study","volume":"13","author":"Mantovani G","year":"2023","unstructured":"Mantovani G, Zangrossi P, Flacco ME,  Styloid jugular nutcracker: the possible role of the styloid process spatial orientation\u2014a preliminary morphometric computed study. Diagnostics (Basel). 2023;13(2):298."},{"issue":"3","key":"b11","series-title":"Neurosurgery","first-page":"E795","article-title":"Styloidogenic jugular venous compression syndrome: diagnosis and treatment: case report","volume":"70","author":"Dashti SR","year":"2012","unstructured":"Dashti SR, Nakaji P, Hu YC,  Styloidogenic jugular venous compression syndrome: diagnosis and treatment: case report. Neurosurgery. 2012;70(3):E795\u2013E799."},{"key":"b12","series-title":"Ann Vasc Surg","first-page":"271.e15","article-title":"Bilateral Eagle syndrome with associated internal carotid artery kinking and significant stenosis","volume":"34","author":"Radak D","year":"2016","unstructured":"Radak D, Tanaskovic S, Kecmanovic V, Babic S, Popov P, Gajin P. Bilateral Eagle syndrome with associated internal carotid artery kinking and significant stenosis. Ann Vasc Surg. 2016;34:271.e15\u2013271.e18."},{"key":"b13","series-title":"Neurology2","first-page":"P7.023","article-title":"Rare presentation of Eagle\u2019s syndrome as Bell\u2019s palsy","volume":"82","author":"Rosales N","unstructured":"Rosales N, Gandhi R LR. Rare presentation of Eagle\u2019s syndrome as Bell\u2019s palsy. Neurology2. 14AD;82(10 suppl):P7.023."},{"issue":"2","key":"b14","series-title":"J Med Soc","first-page":"117","article-title":"Eagle syndrome with multiple cranial nerve involvement","volume":"228","author":"Bedajit RK","year":"2014","unstructured":"Bedajit RK, Priyokumar O, Abhilash RKS. Eagle syndrome with multiple cranial nerve involvement. J Med Soc. 2014;228(2):117\u2013119."},{"issue":"11","key":"b15","series-title":"Head Neck","first-page":"E153","article-title":"Styloid\/C1 transverse process juxtaposition as a cause of Eagle\u2019s syndrome","volume":"37","author":"Ho S","year":"2015","unstructured":"Ho S, Luginbuhl A, Finden S, Curry JM, Cognetti DM. Styloid\/C1 transverse process juxtaposition as a cause of Eagle\u2019s syndrome. Head Neck. 2015;37(11):E153\u2013E156."},{"issue":"1","key":"b16","series-title":"Craniomandib Sleep Pract","first-page":"56","article-title":"Eagle\u2019s syndrome: signs and symptoms","volume":"31","author":"Costantinides F","year":"2013","unstructured":"Costantinides F, Vidoni G, Bodin C, Di Lenarda R. Eagle\u2019s syndrome: signs and symptoms. Craniomandib Sleep Pract. 2013;31(1):56\u201360."},{"issue":"5","key":"b17","series-title":"Clin Anat","first-page":"545","article-title":"Eagle\u2019s syndrome: a review of the literature","volume":"22","author":"Piagkou M","year":"2009","unstructured":"Piagkou M, Anagnostopoulou S, Kouladouros K, Piagkos G. Eagle\u2019s syndrome: a review of the literature. Clin Anat. 2009;22(5):545\u2013558."},{"issue":"7","key":"b18","series-title":"Muscle Nerve","first-page":"858","article-title":"The effect of duration of muscle denervation on functional recovery in the rat model","volume":"20","author":"Kobayashi J","year":"1998","unstructured":"Kobayashi J, Mackinnon SE, Watanabe O, Ball DJ, Gu XM, Hunter DA. The effect of duration of muscle denervation on functional recovery in the rat model. Muscle Nerve. 1998;20(7):858\u2013866."},{"issue":"6","key":"b19","series-title":"Curr Opin Neurol","first-page":"718","article-title":"Traumatic peripheral nerve injuries: diagnosis and management","volume":"35","author":"Barnes SL","year":"2022","unstructured":"Barnes SL, Miller TA, Simon NG. Traumatic peripheral nerve injuries: diagnosis and management. Curr Opin Neurol. 2022;35(6):718\u2013727."},{"issue":"1","key":"b20","series-title":"Plast Reconstr Surg","first-page":"212","article-title":"The effect of two episodes of denervation and reinnervation on skeletal muscle contractile function","volume":"109","author":"Yoshimura K","year":"2002","unstructured":"Yoshimura K, Asato H, Jejurikar SS, Cederna PS, Urbanchek MG, Kuzon WM Jr. The effect of two episodes of denervation and reinnervation on skeletal muscle contractile function. Plast Reconstr Surg. 2002;109(1):212\u2013219."},{"issue":"2","key":"b21","series-title":"Muscle Nerve","first-page":"215","article-title":"Diagnosis of unilateral trapezius muscle palsy: 54 cases","volume":"56","author":"Seror P","year":"2017","unstructured":"Seror P, Stojkovic T, Lefevre-Colau MM, Lenglet T. Diagnosis of unilateral trapezius muscle palsy: 54 cases. Muscle Nerve. 2017;56(2):215\u2013223."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/6\/24\/article-CASE23358.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/6\/24\/article-CASE23358.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/6\/24\/article-CASE23358.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T14:36:50Z","timestamp":1770302210000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/6\/24\/article-CASE23358.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,11]]},"references-count":42,"journal-issue":{"issue":"24"},"URL":"https:\/\/doi.org\/10.3171\/case23358","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,11]]}}}