A CASE PRESENTATION OF ACQUIRED HORNER SYNDROME SECONDARY TO BILATERAL INTERNAL CAROTID ARTERY DISSECTION

Title A CASE PRESENTATION OF ACQUIRED HORNER SYNDROME SECONDARY TO BILATERAL INTERNAL CAROTID ARTERY DISSECTION
Author, Co-Author Ami Halvorson, Kirk Halvorson
Topic
Year
2012
Day
Program Number
125983
Room
Exhibit Hall E
Affiliation
Pacific University, College of Optometry
Abstract BACKGROUND: In nearly 60% of cases, internal carotid artery dissection can present with ophthalmological signs and symptoms such as Horner syndrome's classic clinical triad (miosis, ptosis and anhidrosis), facial, head and neck pain, visual loss or visual disturbances.

CASE REPORT(S): A 37 year old Caucasian male presented with a chief complaint of a headache that started one day prior that was accompanied by ptosis and miosis. Due to the recent onset of his signs and symptoms, pharmacologic testing was deferred and the patient was sent for an emergent CT angiogram of the head and neck. The results of the angiogram indicated a spontaneous internal carotid artery dissection on both the right and left sides. This was later confirmed with MRI and MRA where a sub-acute ischemic event in the left frontal lobe was also identified. He is currently being followed by neurology and is on anti-coagulation therapy.

CONCLUSIONS: It has been estimated that 2.5-2.9% of ischemic strokes in all age groups and up to 20% of ischemic strokes occurring in younger patients may be caused by a carotid artery dissection, as was the case with our patient.

There are several different potential causes of carotid artery dissection including trauma, genetic factors such as connective tissue disorders, infections, migraines, smoking, hypertension or contraceptive use. Occasionally spontaneous ICA dissections can occur.

In most cases of ICA dissection, spontaneous healing of the internal carotid artery will occur while the patient is on anti-platelet therapy but in rare cases the patient will be considered for surgical therapy if they continue to show persistent symptoms of ischemia. Horner syndrome is often a long-term ocular sequelae, but has been reported, on occasion, to resolve after the diagnosis.

It is important to recognize the signs and symptoms of Horner syndrome as it relates to an internal carotid artery dissection because early detection and treatment initiation can potential prevent the devastating sequelae of an impending stroke.
Affiliation of Co-Authors Private Practitioner
Outline