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Beware of Old Horner Syndrome

Adamec, Ivan; Matijević, Vesna; Pavliša, Goran; Zadro, Ivana; Habek, Mario

doi: 10.1097/OPX.0b013e318269cd69
Clinical Communications

Purpose. Chronic Horner syndrome is a rare clinical condition, the etiology of which often remains undiscovered. A patient is presented with an 8-year history of Horner syndrome who was diagnosed with multiple cervical artery dissections.

Case report. A 42-year-old woman presented to our emergency department with a severe occipital headache that woke her up from sleep 3 days earlier. She had a history of headaches and recalled one in particular dating back to 2003. At that time, she sought medical attention at general practitioner's office because of the terrible headache and a noticeable disparity of her pupils. She was told that she had miosis of the right pupil. The examination conducted in 2011 revealed Horner syndrome with right miosis and ptosis. A four-vessel cerebral angiography revealed an occlusion of the right internal carotid artery. The morphology of stenosis and pseudoaneurysm of C1 segment of left internal carotid artery, as well as a pseudoaneurysm of V3/V4 junction of left vertebral artery indicated a probable dissective etiology.

Conclusions. This case illustrates that Horner syndrome with a chronic presentation can be as potentially dangerous as its acute counterpart and should be judiciously investigated.



Department of Neurology, Refferal Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Zagreb, Croatia (IA, VM, IZ, MH), Department of Radiology, University Hospital Center Zagreb, Zagreb, Croatia (GP), and Department of Neurology, School of Medicine, University of Zagreb, Zagreb, Croatia (MH).

Received January 26, 2012; accepted March 27, 2012.

Ivan Adamec University Department of Neurology University Hospital Center Zagreb Kišpatićeva 12 HR-10000 Zagreb Croatia e-mail:

© 2012 American Academy of Optometry