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Carotid Artery Dissection — SCE Neurology MCQ

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ModerateCerebrovascular DiseaseCarotid Artery DissectionSCE Neurology

A 50-year-old man is found to have a unilateral Horner syndrome (miosis, ptosis, anhidrosis of the face). He also has ipsilateral neck pain and a contralateral hemiparesis. MRI angiography of the neck confirms the underlying cause. What is the most likely aetiology?

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Correct answer: C — Internal carotid artery dissection

The combination of an acute Horner syndrome with ipsilateral neck/facial pain and contralateral neurological deficit (hemiparesis from subsequent stroke) is classic for internal carotid artery dissection. The sympathetic fibres run along the internal carotid artery and are disrupted by the dissection. MRA or CTA confirms the diagnosis. A: Pancoast tumour causes a pre-ganglionic Horner syndrome without stroke. C: A brainstem stroke could cause Horner syndrome but would not typically cause neck pain as the presenting feature. D: Cluster headache causes a transient Horner syndrome without hemiparesis. E: Syringomyelia causes a central cord syndrome.

Reference: RCP National Clinical Guideline for Stroke (2023)