Spontaneous dissection of the internal carotid artery is an uncommon disorder that is almost always associated with angiographic evidence of dissection.1 We report a case of Horner's syndrome secondary to spontaneous subadventitial internal carotid artery dissection associated with normal angiographic findings. Magnetic resonance imaging (MRI) demonstrated the subadventitial dissection.
Report of a Case.
—A 57-year-old hypertensive man complained of a droopy left upper eyelid and mild scalp tenderness. One week earlier, he had developed generalized weakness, postural dizziness, and nausea. Several days later, he developed a dull ache around his left eye, cheek, and anterior aspect of the neck, as well as a faint metallic taste in his mouth.Examination revealed a blood pressure of 170/120 mm Hg. Visual acuity was 20/20 OU. There was 1-mm ptosis of the left upper eyelid. Pupillary testing demonstrated dilation lag in the left eye, with relative miosis that increased in dim illumination.