Author: Belal Zakieldin Elabd / Editor: Sarah Edwards / Codes: NeuP2, SLO3, SLO7 / Published: 09/03/2026
A 50-year-old man presents to the Emergency Department (ED) with left retro-orbital discomfort and a droopy left eyelid noticed by his wife this morning. He experienced one brief episode of dizziness that resolved. He reports no trauma, thunderclap headache, visual changes, or other neurological symptoms. His past medical history is unremarkable; he is very fit and ex-military.
On examination, he is haemodynamically stable and appears well. Neurological examination confirms a left partial ptosis and miosis, consistent with Horner’s syndrome. The remainder of the neurological and systemic examinations is normal. Carotid artery dissection is suspected, and urgent CT head and CT angiography of the head and neck are requested. The CT head is reported as normal, with no acute pathology.
4 responses
Great clinical case
Beautifully explained the pathology
I really like how this is presented, it’s a great reminder that in ED we shouldn’t automatically defer to specialty colleagues.
Good one !!