title: Incidental discovery of carotid artery dissection as a cause of horner's syndrome and headache in a patient presenting for follow-up of lumbar epidural steroid injection: a case report with a three year follow-up.
abstract: OBJECTIVE
  To describe management challenges and follow-up data for three years in a case with spontaneous carotid artery dissection (SCAD).
  
  
  METHODS
  We present a case of SCAD that presented with Horner's syndrome and headache. The patient developed the SCAD, Horner's syndrome and headache one month after a lumbar epidural steroid injection for radicular pain. Three years follow-up experience with therapeutic challenges is described.
  
  
  CONCLUSIONS
  A life threatening cause of headache is described which occurred one month after receiving an uneventful lumbar epidural steroid injection. Despite no carotid arterial luminal flow restriction and anticoagulation, the headache and Horner's syndrome persisted for three years. Stellate ganglion blocks were able to relieve both neck pain and headache temporarily. In patients with new onset headache and Horner's syndrome SCAD must be ruled out. If SCAD is detected, appropriate therapy including anticoagulation must be instituted immediately, since the potential for continued dissection or embolization remain significant.
authors.affiliation: Pain Management Center, VA Tennessee Valley Healthcare System, Nashville Campus, 1310 24th Avenue South, Nashville, TN 37212, USA. sukdeb@hotmail.com
authors.forename: Sukdeb
authors.initials: S
authors.lastname: Datta
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Candido