title: Beware of "old" Horner syndrome.
abstract: OBJECTIVE
  Chronic Horner syndrome is a rare clinical condition, the etiology of which often remains undiscovered. A patient is presented with an 8-year history of Horner syndrome who was diagnosed with multiple cervical artery dissections.
  
  
  METHODS
  A 42-year-old woman presented to our emergency department with a severe occipital headache that woke her up from sleep 3 days earlier. She had a history of headaches and recalled one in particular dating back to 2003. At that time, she sought medical attention at general practitioner's office because of the terrible headache and a noticeable disparity of her pupils. She was told that she had miosis of the right pupil. The examination conducted in 2011 revealed Horner syndrome with right miosis and ptosis. A four-vessel cerebral angiography revealed an occlusion of the right internal carotid artery. The morphology of stenosis and pseudoaneurysm of C1 segment of left internal carotid artery, as well as a pseudoaneurysm of V3/V4 junction of left vertebral artery indicated a probable dissective etiology.
  
  
  CONCLUSIONS
  This case illustrates that Horner syndrome with a chronic presentation can be as potentially dangerous as its acute counterpart and should be judiciously investigated.
authors.affiliation: Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia. ivan.adamec@yahoo.com
authors.forename: Ivan
authors.initials: I
authors.lastname: Adamec
authors.forename: Vesna
authors.initials: V
authors.lastname: Matijević
authors.forename: Goran
authors.initials: G
authors.lastname: Pavliša
authors.forename: Ivana
authors.initials: I
authors.lastname: Zadro
authors.forename: Mario
authors.initials: M
authors.lastname: Habek
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006732:Horner Syndrome / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D014057:Tomography, X-Ray Computed; D020217:Vertebral Artery Dissection / Q000175:diagnosis / Q000209:etiology*