Long Phone Call Results In "Mini-Stroke" For Psychiatrist

The 43-year-old spent more than an hour talking to a patient, holding the phone between his left ear and shoulder so he could keep his hands free. Shortly after the call, the doctor experienced a temporary blindness in his left eye, followed by a pulsing ringing in his left ear and difficulty speaking.

An angiogram of the patient's brain showed a tear in the wall of the internal carotid artery, a key blood vessel supplying the brain, eyes and other structures in the head.

"There were no signs of a predisposition to arterial disease, but a CT scan showed that a bony structure was directly in contact with his internal carotid artery," said neurologist Mathieu Zuber, MD, of Sainte-Anne Hospital in Paris, France.

That bony structure was the psychiatrist's styloid process, a slender, pointed bone that projects from both sides of the skull under the ears and behind the jaw. Each of us has two of them, but this man's was unusually long.

Long styloid processes could be a more common cause of tears, or dissections, in the internal carotid artery than was previously thought, Zuber said. About 20 percent of strokes in young adults are caused by dissections, he said.

"Fortunately, this patient had only a transient ischemic attack, or a brief interruption in blood flow to the brain that resolved in less than 24 hours," Zuber said. "But this case shows us that everyday activities with a prolonged distortion of the neck, such as holding the phone between your ear and shoulder, can have unpredictable consequences for some people.

"Unfortunately, there is no simple procedure to identify people with long styloid processes. There haven't been any studies to determine how common these long styloid processes are, but they could be occurring more frequently than was generally thought."

The psychiatrist's symptoms disappeared within a few hours. He was given anticoagulants for three months to keep his blood from clotting. "He's had no more symptoms, but now he avoids holding the phone between his ear and shoulder for long periods," Zuber said.

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The American Academy of Neurology, an association of more than 16,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research.