Carotid artery dissection is a significant cause of ischaemic stroke and the second leading cause among young patients. It commonly presents with Horner’s syndrome associated with headache, facial or neck pain. Diagnosis is now usually made with magnetic resonance angiography, although invasive angiography remains the gold standard. The management of carotid artery dissection is controversial but most authorities advocate anticoagulation with warfarin for six months. In patients with frequent thromboembolic events despite optimum medical therapy, endovascular stenting or surgery can be considered. Prognosis is variable but is more favourable when focal neurological signs are present.1 This is important when deciding whether such patients require anticoagulation.

Carotid artery dissection is a rare occurrence and diagnosis requires high clinical suspicion. It should be suspected in all patients presenting with focal neurological signs, especially Horner’s syndrome with headache, facial or neck pain.

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Figure 1 Left-sided Horner’s syndrome in a patient with carotid artery dissection. Informed consent was obtained for publication of this figure.