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Recurrent horner syndrome and persistent trigeminal artery.
Andrea Rigamonti1, Giuseppe Lauria, Valentina Prone
1Neurological Department, A. Manzoni Hospital, Lecco, Italy. rig74@libero.it
The Neurologist
|November 2, 2012
Summary
Persistent primitive trigeminal artery (PTA) is rare. This case report details a unique association between PTA and Horner syndrome during hypertensive crisis, highlighting the importance of managing blood pressure in patients with this vascular variant.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Persistent primitive trigeminal artery (PTA) is a rare fetal remnant, typically asymptomatic.
- PTA prevalence is low (0.1-0.7%), often discovered incidentally.
- Symptomatic cases of PTA can manifest with cranial nerve dysfunction.
Observation:
- A 40-year-old male presented with recurrent hypertensive crises and left-sided Horner syndrome.
- Symptoms included dizziness, tachycardia, facial flushing, ptosis, miosis, and conjunctival injection.
- Imaging confirmed a left PTA with proximal ectasia.
Findings:
- The study describes the first reported case of persistent PTA associated with ipsilateral Horner syndrome during hypertensive crisis.
- The Horner syndrome is hypothesized to result from disruption of pericarotid plexus fibers due to elevated blood pressure.
- Antihypertensive therapy successfully resolved the patient's symptoms.
Implications:
- This case highlights an unusual presentation of PTA.
- Management of hypertensive crises is crucial for patients with PTA variants.
- Early diagnosis and treatment can alleviate symptoms associated with PTA and associated neurological conditions.
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