Brief, transient Horner's syndrome can be the hallmark of a carotid artery dissection.
We describe a 41-year-old woman in whom the diagnosis of carotid artery dissection was suspected based on a recent history of anisocoria and ipsilateral ptosis that lasted 2 days. She had a normal neurologic examination, including no clinical evidence of anisocoria or ptosis. Subsequently, a cocaine test demonstrated pharmacologic Horner's syndrome. MRI confirmed the carotid dissection. This patient illustrates that a history of transient pupillary and eyelid abnormalities can lead to the diagnosis of a carotid dissection. Specific questioning about transient anisocoria and ptosis should be considered when a carotid artery dissection is suspected. Pharmacologic testing may be a useful tool in such instances.
Leira
E C
EC
Department of Neurology (Cerebrovascular Diseases), University of Iowa College of Medicine, Iowa City 52242-1053, USA.
Bendixen
B H
BH
Kardon
R H
RH
Adams
H P
HP
D000328:Adult; D000779:Anesthetics, Local; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis; D015875:Anisocoria / Q000175:diagnosis; D002340:Carotid Artery Diseases / Q000150:complications* / Q000175:diagnosis; D003042:Cocaine; D005260:Female; D006732:Horner Syndrome / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging
D000779:Anesthetics, Local; D003042:Cocaine