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But it's not all there.
Jared D Peterson1, Jurij R Bilyk, Robert C Sergott
1Wills Eye Institute, Philadelphia, PA 19107, USA.
Survey of Ophthalmology
|July 13, 2012
Summary
Horner syndrome can occur with anisocoria and dilation lag, even without eyelid ptosis. Early diagnosis via cocaine testing and neuroimaging is crucial for conditions like carotid artery dissection.
Area of Science:
- Neurology
- Ophthalmology
- Vascular Neurology
Background:
- Anisocoria, or unequal pupil size, can be a sign of serious neurological conditions.
- Horner syndrome is characterized by ptosis, miosis, and anhidrosis, but presentations can vary.
Observation:
- A 44-year-old man presented with acute headache and isolated anisocoria with dilation lag.
- Clinical suspicion of Horner syndrome persisted despite the absence of ptosis.
- Cocaine testing confirmed the diagnosis of Horner syndrome.
Findings:
- Urgent neuroimaging revealed an internal carotid artery dissection.
- The patient was successfully treated with systemic anticoagulation.
- This case highlights a less typical presentation of Horner syndrome.
Implications:
- Horner syndrome should be considered in patients with anisocoria and dilation lag, even without classic symptoms like ptosis.
- Prompt diagnosis and management of internal carotid artery dissection are vital.
- This case underscores the importance of thorough pupil examination in neurological assessments.
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