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Simultaneous Horner’s syndrome with anhidrosis and facial nerve palsy in internal carotid artery dissection
  1. Tharuka Herath1,
  2. Tsneem H S Mbydeen1,
  3. Savindu Alagoda2,
  4. May Saleh1,
  5. Leena Naidu1,
  6. Sunil Wimalaratna3
  1. 1 Kettering General Hospital, Kettering, UK
  2. 2 University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
  3. 3 Neurology, Kettering General Hospital, Kettering, UK
  1. Correspondence to Dr Tharuka Herath, Kettering General Hospital, Kettering, Northamptonshire, UK; tharukaherath11{at}gmail.com

https://doi.org/10.1136/pn-2023-004038

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    Case report

    A 54-year-old man developed acute-onset right-sided neck and ear pain, right lower motor neurone facial nerve palsy and right-side Horner’s syndrome following a fall with hyperextension of the neck. He also had right facial anhidrosis. MR scan and MR angiogram of the head and neck identified a right internal carotid artery dissection at the skull base (figure 1). He was treated conservatively with antiplatelet therapy. After 2 months, his facial palsy had almost resolved (figure 2A) but partial ptosis with miosis remained (figure 2B). Starch iodine test confirmed the absence of right facial sweating (figure 2C) but without contralateral facial flushing or ipsilateral pallor.

    Figure 1

    MR scan of head and neck. (A) axial, (B) coronal, (C) sagittal T1 non-contrast and (D) coronal T1 fat-saturated postcontrast showing right internal carotid artery dissection with peripheral T1 hyperintense signal (thrombus) and patent signal void residual lumen (arrow); (E) MR angiogram of the right internal carotid artery dissection showing patent residual lumen and surrounding thrombus.

    Figure 2

    (A) Right-sided lower motor neurone type …

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    Footnotes

    • Contributors All the authors contributed equally.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed by Jeremy Chataway, London, UK.