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Reminder of important clinical lesson
Internal carotid artery dissection secondary to excessive vocal output
  1. Nashila Hirji,
  2. Alexander Ionides
  1. Department of Ophthalmology, Moorfields at St George's Hospital, London, UK
  1. Correspondence to Dr Nashila Hirji, nashila{at}


A previously healthy 61-year-old male presented to eye casualty with a left-sided Horner's syndrome. He reported that while offering strong vocal support at a football match 5 days previously, he had suddenly noticed an unusual sensation behind his left eye, accompanied by a left hemifacial headache. He had noted pupillary asymmetry soon after this. Radiological imaging revealed a left internal carotid artery dissection. Anticoagulant therapy was commenced, and all symptoms and signs had fully resolved at 1-month follow-up, with no further complications.

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  • Competing interests None.

  • Patient consent Obtained.

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