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M. Shaw, T. J. Whittaker; Horner's Syndrome Caused by Carotid Dissection Missed on Radiological Reports. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1458.
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Carotid artery dissection is an infrequent, but important, cause of Horner’s syndrome. Accurate diagnosis is critical to improving symptoms and avoiding devastating complications. The purpose of this study is to evaluate cases in which Horner’s syndrome caused by carotid dissection evident on imaging were missed by the radiologist.
A consecutive case series of patients diagnosed with Horner’s syndrome over the past ten years at a single academic center were reviewed retrospectively. The charts of patients with a preganglionic Horner’s syndrome caused by carotid dissection were selected and separated into two groups: those in which a carotid dissection was identified by the radiologist and those with a false negative report with later identification of the presence of a carotid dissection either by subsequent imaging or review of the same images by the neuro-ophthalmologist. Charts were excluded from the study if imaging results were not available.
The charts of ninety-four patients diagnosed with Horner’s syndrome over the past ten years at a single academic institution were reviewed. Of the fifty charts reviewed thus far, six patients (12%) had a Horner’s syndrome caused by carotid dissection evident on imaging. Of these six, three (50%)had initial CT imaging that was read as normal on the final radiology report. In one of the three cases (33%), the original CT image was reviewed by the neuro-ophthalmologist identifying the presence of a carotid dissection, later confirmed by the radiologist. In the remaining two cases (66%), subsequent MRA imaging confirmed the presence of a carotid dissection.
Carotid dissection is an important etiology of Horner’s syndrome that is under diagnosed. A high suspicion of the diagnosis should prompt additional investigation either with re-evaluation of images by the neuro-ophthalmologist or with additional studies.
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