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Neurology (Expert Forum)
horner's syndrome
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horner's syndrome
by paolo2141, Feb 06, 2005 12:00AM
Hi there i was wondering if you could help i had a bad fall 3months ago where i landed right on base of spine and impact seemed to travel all way up to back of skull as i had severe pain in back of head for few seconds which quickly dissapeared.About 2 weeks later i began to get quite noticeable pain in head and neck region along with tingling down left side of cheek ans in left arm as well as severe dizziness and nausea.After trip to er i was diagnosed with post whiplash syndrome.However a few weeks later i noticed right pupil seemed smaller than left especially in dark and eyelid seemed fractionally droopier seen a neurlogist who wasnt convinced it was too serious and said he would arrange an mri scan non-urgent.However just over 2weeks ago i was diagnosed with cocaine test as having incopmlete right sided horner's syndrome with a queery as to possible carotid artery dissection by an opthamologist.She is trying to hurry my neurologist up to do scan quicker although he does not seem to concerned at moment.I should mention that even before fall i was under a neurologist for some similar symptoms without the horner's syndrome and i had abnormal lumbar puncture results 6months ago where my csf contained 17lymphocytes,i think he thinks horner's yndrome is more likely related to this problem.My question is should i be receiving an urgent scan or is it likely that even if it was an atery dissection it might be too late to pick it up after 3months,i have been on aspirin 110mg daily which i started myself just coincidentally few days after fall,any help much appreciated.
Doctor's Answer
by CCF-Neuro-M.D.-CS, Feb 07, 2005 12:00AM
I cannot give a clinical diagnosis over the internet
It is possible that if you had a sufficient force/turn to the neck when you fell, you may have torn or dissected a carotid artery where the fibers supplying the eye dilator muscle travel. This should be ruled out by MRI and/or dye angiography. It should still be possible to see a dissection at this point - if one is present the treatment at this point (3 months after) is just an antiplatelet agent like aspirin - it heals spontaneously. The risk for the artery to be blocked or break off blood clots and cause a stroke is greatest in the first few weeks, after this any clot organises and heals up.
Its also possible that the fall was conincidental and it is due to another cause - this should be followed with your neurologist
Good luck
It is possible that if you had a sufficient force/turn to the neck when you fell, you may have torn or dissected a carotid artery where the fibers supplying the eye dilator muscle travel. This should be ruled out by MRI and/or dye angiography. It should still be possible to see a dissection at this point - if one is present the treatment at this point (3 months after) is just an antiplatelet agent like aspirin - it heals spontaneously. The risk for the artery to be blocked or break off blood clots and cause a stroke is greatest in the first few weeks, after this any clot organises and heals up.
Its also possible that the fall was conincidental and it is due to another cause - this should be followed with your neurologist
Good luck
