title: Painful isolated Horner's syndrome caused by pontine ischaemia.
abstract: OBJECTIVE
  To alert ophthalmologists to the possibility of brainstem ischaemia in patients with isolated Horner's syndrome.
  
  
  METHODS
  Observational case report.
  
  
  METHODS
  Neuro-ophthalmological and neuroimaging assessment of a 59-year-old woman presenting with an isolated Horner's syndrome after an episode of headache.
  
  
  RESULTS
  Horner's syndrome was pharmacologically localised to a first- or second-order sympathetic neuron on the right. Magnetic resonance imaging (MRI) showed a small ischaemic lesion at the transition between pons and midbrain, lateral to the anterolateral system involving the sympathetic tract on the right side.
  
  
  CONCLUSIONS
  An isolated Horner's syndrome may be the presenting sign of a brainstem infarction. This case report stresses the importance of a rational approach to Horner's syndrome and the need to order accurate MRI.
authors.affiliation: Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 , Ghent, Belgium. luc.crevits@ugent.be.
authors.forename: Luc
authors.initials: L
authors.lastname: Crevits
authors.affiliation: Department of Anatomy and Embryology, Ghent University, Ghent, Belgium.
authors.forename: Katharina
authors.initials: K
authors.lastname: D'Herde
authors.affiliation: Department of Radiology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Karel
authors.initials: K
authors.lastname: Deblaere
mesh_terms: D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis; D001933:Brain Stem / Q000473:pathology*; D005260:Female; D006261:Headache / Q000150:complications; D006732:Horner Syndrome / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged