title: Clinical import of Horner syndrome in internal carotid and vertebral artery dissection.
abstract: OBJECTIVE
  To study the prognostic importance of Horner syndrome (HS) in patients with internal carotid artery dissection (ICAD) or vertebral artery dissection (VAD).
  
  
  METHODS
  In this observational study, characteristics and outcome of patients with ICAD or VAD from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) database were analyzed. The presence of HS was systematically assessed using a standardized questionnaire. Patients with HS (HS+) were compared with HS- patients. Crude odds ratios (ORs) with 95% confidence intervals and ORs adjusted for age, sex, center, arterial occlusion, bilateral dissection, stroke severity, and type of antithrombotic treatment were calculated.
  
  
  RESULTS
  We analyzed 765 patients (n = 496 with ICAD, n = 269 with VAD, n = 303 prospective, n = 462 retrospective). HS was present in 191 (38.5%) of the patients with ICAD and 36 (13.4%) of the patients with VAD (p < 0.001). HS+ ICAD patients presented less often with stroke or TIA (p < 0.001), less often had bilateral (p = 0.019) or occlusive (p = 0.001) dissections, and had fewer severe strokes (p = 0.041) than HS- ICAD patients. HS+ ICAD patients had a better functional 3-month outcome than those without HS (ORcrude = 4.0 [2.4-6.7]), and also after adjustment for outcome-relevant covariates (ORadjusted = 2.0 [1.1-4.0]). HS+ ICAD patients were less likely to have new strokes than HS- ICAD patients (p = 0.039). HS+ VAD patients more often had vessel occlusion (p = 0.014) than HS- patients but did not differ in any of the other aforementioned variables.
  
  
  CONCLUSIONS
  In patients with ICAD, HS is an easily assessable marker that might indicate a more benign clinical course. HS had no prognostic meaning in patients with VAD.
authors.affiliation: From the Department of Neurology (P.A.L., L.H.B., H.G., S.T.E.), Basel University Hospital, Switzerland; Department of Neurology (T.B., M.K., C.L., C.G.-G.), Heidelberg University Hospital; Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Finland; Department of Neurology (S.D.), Hôpital Lariboisière, Paris; Department of Neurology (S.D., D.L.), University Lille Nord de France, EA 1046, Lille, France; Stroke Unit (V.C.), Perugia University Hospital; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Cerebrovascular Unit (A.B.), IRCCS Foundation C. Besta Neurological Institute, via Celoria 11, Milan, Italy; University of Caen Basse Normandie (E.T.), INSERM U919, Department of Neurology, CHU Côte de Nacre, Caen, France; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; and Neurorehabilitation Unit (S.T.E.), Geriatric Competence Center, Felix Platter-Spital, Basel, Switzerland.
authors.forename: Philippe A
authors.initials: PA
authors.lastname: Lyrer
authors.forename: Tobias
authors.initials: T
authors.lastname: Brandt
authors.forename: Tiina M
authors.initials: TM
authors.lastname: Metso
authors.forename: Antti J
authors.initials: AJ
authors.lastname: Metso
authors.forename: Manja
authors.initials: M
authors.lastname: Kloss
authors.forename: Stephanie
authors.initials: S
authors.lastname: Debette
authors.forename: Didier
authors.initials: D
authors.lastname: Leys
authors.forename: Valeria
authors.initials: V
authors.lastname: Caso
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pezzini
authors.forename: Leo H
authors.initials: LH
authors.lastname: Bonati
authors.forename: Vincent
authors.initials: V
authors.lastname: Thijs
authors.forename: Anna
authors.initials: A
authors.lastname: Bersano
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Touzé
authors.forename: Henrik
authors.initials: H
authors.lastname: Gensicke
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Martin
authors.forename: Christoph
authors.initials: C
authors.lastname: Lichy
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
authors.forename: Stefan T
authors.initials: ST
authors.lastname: Engelter
authors.forename: Caspar
authors.initials: C
authors.lastname: Grond-Ginsbach
mesh_terms: D000328:Adult; D020215:Carotid Artery, Internal, Dissection / Q000150:complications*; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006732:Horner Syndrome / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D020217:Vertebral Artery Dissection / Q000150:complications*