BMJ Case Reports 2018; doi:10.1136/bcr-2018-225660
  • Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Hit by the wave: a case of painful Horner’s and intramural haematoma of the carotid

  1. David Gallagher3
  1. 1Department of Emergency Medicine, Galway University Hospitals, Galway, Ireland
  2. 2Department of Radiology, Galway University Hospitals, Galway, Ireland
  3. 3Acute Medical Unit (AMU), Galway University Hospital, Galway, Ireland
  1. Correspondence to Dr Etimbuk Umana, etimbukumana{at}
  • Accepted 15 August 2018
  • Published 12 September 2018


Carotid artery dissection from rupture of the vasa vasorum is under-recognised. We report the case of a 60-year-old woman presenting to our hospital with a 2-week history of right-sided headache, neck pain, unequal pupils and ptosis after being hit by a wave on the beach. She was diagnosed with painful Horner’s syndrome. MR angiogram revealed dissection of the right internal carotid artery with an intramural haematoma without an intimal flap. A diagnosis of carotid artery dissection from rupture of the vasa vasorum was made. Initial antithrombotic (aspirin and clexane) were stopped as she was deemed a low stroke risk with no signs of ischaemia on MR brain. Her clinical course was uneventful with resolution of the intramural haematoma seen on repeat MR angiogram.


  • Contributors EU was the admitting doctor and was involved in patient consent and drafted the manuscript. RB and ID were involved in reviewing images and manuscript revision. DG was the admitting consultant and was involved in manuscript revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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