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November 1991

Horner's Syndrome Secondary to Spontaneous Carotid Dissection With Normal Angiographic Findings

Author Affiliations

Cleveland, Ohio

Arch Ophthalmol. 1991;109(11):1499-1500. doi:10.1001/archopht.1991.01080110033022

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.

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