Spontaneous Internal Carotid Ariery Dissection and Abnormal Facial Sweating

To the Editor.—  We were very interested in the article "Spontaneous Internal Carotid Dissection, Hemicrania, and Horner's Syndrome," by Mokri et al (Archives 36:677-680, 1979). The authors indicated that oculosympathetic paralysis and headache are common manifestations of spontaneous dissection of the internal carotid artery. This is also true of other lesions in this region, including aneurysms, thrombosis, infections, etc. This fact is often overlooked by clinicians.We have studied a number of patients with a similar neurological syndrome, but without dissection of the internal carotid artery.¹ These patients were mostly middle-aged men in whom a uniphasic disease developed that was characterized by headaches and oculosympathetic paralysis without other neurological manifestations. All investigations to localize the sympathetic lesion pointed to a pericarotid location. One patient had an internal carotid occlusion, but angiograms in the rest were normal. No clear-cut explanations for these cases were available, except for circumstantial evidence that