Clinical import of Horner syndrome in internal carotid and vertebral artery dissection

Lyrer, Philippe; Brandt, Tobias; Metso, Tiina M.; Metso, Antti J.; Kloß, Manja; Debette, Stéphanie; Leys, Didier; Caso, Valeria; Pezzini, Alessandro; Bonati, Leo H.; Thijs, Vincent; Bersano, Anna; Touzé, Emmanuel; Gensicke, Henrik; Martin, Juan-Jose; Lichy, Christoph; Tatlısumak, Turgut; Engelter, Stefan T.; Grond‐Ginsbach, Caspar

doi:10.1212/wnl.0000000000000381

Cited by 46 publications

(26 citation statements)

References 26 publications

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“…In this study the focus was on easily assessable clinical parameters (age, sex, NIHSS, Horner syndrome, pain and PT) to allow the treating physician to gain a quick overview of patients‘ characteristics which might be associated with more benign course. As recently reported for Horner syndrome, PT is associated with a more benign clinical course of CeAD . Our study did not attempt to discover the mechanism behind PT in CeAD but rather described the authentic clinical situation in these patients.…”

Section: Discussionmentioning

confidence: 81%

Prognostic significance of pulsatile tinnitus in cervical artery dissection

Kellert

Kloß

Pezzini

et al. 2016

Euro J of Neurology

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Section: Discussionmentioning

confidence: 81%

Prognostic significance of pulsatile tinnitus in cervical artery dissection

Kellert

Kloß

Pezzini

et al. 2016

Euro J of Neurology

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“…Intracranial dissections are associated with subarachnoid hemorrhage (SAH) . Horner's syndrome is more common in carotid dissections (38%, from injury to the sympathetic fibers than run along the vessel) than in VAD (13% from a lateral medullary infarct) …”

Section: Discussion/observationsmentioning

confidence: 99%

Avoiding Misdiagnosis in Patients With Posterior Circulation Ischemia: A Narrative Review

Gurley

Edlow

2019

Academic Emergency Medicine

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Posterior circulation strokes represent 20% of all acute ischemic strokes. Posterior circulation stroke patients are misdiagnosed twice as often compared to those with anterior events. Misdiagnosed patients likely have worse outcomes than correctly diagnosed patients because they are at risk for complications of the initial stroke as well as recurrent events due to lack of secondary stroke prevention and failure to treat the underlying vascular pathology.Understanding important anatomic variants, the clinical presentations, relevant physical examination findings, and the limitations of acute brain imaging may help reduce misdiagnosis. We present a symptom-based review of posterior circulation ischemia focusing on the subtler presentations with a brief discussion of basilar stroke, both of which can be missed by the emergency physician. Strategies to avoid misdiagnosis include establishing an abrupt onset of symptoms, awareness of the nonspecific presentations, consideration of basilar stroke in altered patients and using a modern approach to diagnosis of the acutely dizzy patient.

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“…Painful Horner’s syndrome has been reported in approximately 25%–60% of patients with CAD 2 5 6. Lyrer et al carried out an observational study using the Cervical Artery Dissection and Ischemic Stroke Patient (CADISP) database, which showed that Horner’s was present in one-third of patients with CAD and Horner’s presented less often with stroke or TIA than CAD without Horner’s 5. Also, they proposed that Horner’s syndrome in patient with CAD was an independent outcome predictor and a possible indicator of low stroke risk 5…”

Section: Discussionmentioning

confidence: 99%

Hit by the wave: a case of painful Horner’s and intramural haematoma of the carotid

Umana¹,

Bajwa

Davidson

et al. 2018

BMJ Case Reports

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Carotid artery dissection from rupture of the vasa vasorum is under-recognised. We report the case of a 60-year-old woman presenting to our hospital with a 2-week history of right-sided headache, neck pain, unequal pupils and ptosis after being hit by a wave on the beach. She was diagnosed with painful Horner's syndrome. MR angiogram revealed dissection of the right internal carotid artery with an intramural haematoma without an intimal flap. A diagnosis of carotid artery dissection from rupture of the vasa vasorum was made. Initial antithrombotic (aspirin and clexane) were stopped as she was deemed a low stroke risk with no signs of ischaemia on MR brain. Her clinical course was uneventful with resolution of the intramural haematoma seen on repeat MR angiogram.

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Clinical import of Horner syndrome in internal carotid and vertebral artery dissection

Abstract: In patients with ICAD, HS is an easily assessable marker that might indicate a more benign clinical course. HS had no prognostic meaning in patients with VAD.

Cited by 46 publications

References 26 publications

Prognostic significance of pulsatile tinnitus in cervical artery dissection

Prognostic significance of pulsatile tinnitus in cervical artery dissection

Avoiding Misdiagnosis in Patients With Posterior Circulation Ischemia: A Narrative Review

Hit by the wave: a case of painful Horner’s and intramural haematoma of the carotid

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