Horner's syndrome secondary to angiogram negative, subadventitial carotid artery dissection

A 59-year-old man presented with the acute onset of paresthesias and pain in the left neck, face, and forehead. On subsequent investigation he was found to have a subadventitial type of carotid artery dissection, producing an ipsilateral Horner's syndrome with normal carotid angiography. MRI imaging of the neck structures, using fat saturation technique, showed the subadventitial dissection, sparing the vessel lumen. MRI offers a non-invasive method of diagnosis and follow-up for carotid artery dissection.