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

Spontaneous dissection of the internal carotid artery is an uncommon disorder that is almost always associated with angiographic evidence of dissection.1We 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.