Abstract
Internal carotid dissection can be responsible for stroke and lead to severe neurological
and functional complications. Thus, it must be diagnosed and treated with heparin
as soon as possible. Horner syndrome is one of the most usual manifestations of internal
carotid dissection. We report the case of a patient who presented with a unilateral
non-reactive enlargement of the right pupil that did not last longer than 30 s. As
a carotid dissection was not recognized from this atypical symptomatology, magnetic
resonance angiography was performed only a few days later when Horner syndrome occurred.
It disclosed a dissection of the internal carotid artery ipsilateral from its origin.
The evolution and the duration of the pupil involvement suggest that the initial episode
of mydriasis was caused by an oculosympathetic spasm, a rare form of sympathetic dysfunction
that can be observed when the sympathetic nerve or the pericarotid plexus is irritated.
It is important to recognize this oculosympathetic spasm because it has equal value
as Horner syndrome for the diagnosis of internal carotid dissection.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Brief, transient Horner's syndrome can be the hallmark of a carotid artery dissection.Neurology. 1998; 50: 289-290
- Mydriatic pupil as the presenting sign of common carotid artery dissection.Stroke. 1998; 29: 2653-2655
- Ocular motor nerve palsies in spontaneous dissections of the cervical internal carotid artery.Neurology. 1993; 43: 1938-1941
- Chapter 31: Disorders of pupillary function, accommodation and lacrymation.in: Miller N.R. Walsh and Hoyt's clinical neuro-ophthalmology. Williams and Wilkins, Baltimore, MD1985: 469-559
- Carotid disease and the eye.Curr Opin Ophthalmol. 1997; 8: 16-26
- Ischemic optic neuropathy associated with internal carotid artery dissection.Arch Neurol. 1998; 55: 715-719
- Transient ocular motor paresis associated with acute internal carotid artery occlusion.Ann Neurol. 1989; 25: 286-290
- Oculosympathetic spasm with cervical spinal cord injury.Arch Neurol. 1984; 41: 61-64
- Occlusion of the anterior spinal artery in the cervical cord with sympathetic spasm of the pupil on finger movements.Neurology. 1959; 62: 458-464
- Ispilateral mydriasis following carotid artery puncture during attempted cannulation of the internal jugular vein.Anesthesiology. 1980; 52: 438-439
Article info
Publication history
Published online: May 06, 2008
Accepted:
October 30,
2007
Received in revised form:
May 17,
2007
Received:
October 24,
2006
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
