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      Síndrome de Horner como manifestación de disección carotídea Translated title: Horner syndrome as a manifestation of carotid artery dissection

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          Abstract

          Caso Clínico: Un varón de 42 años se presenta con ptosis y miosis izquierda después de una historia de cefalea homolateral de 20 días de evolución, que empeora progresivamente durante los últimos días. Una angioresonancia revela disección de la arteria carótida interna. Discusión: El «síndrome de Horner doloroso» destaca como una urgencia médica por posible manifestación de una disección carotídea. Consideramos que el perfecto conocimiento de las urgencias neurooftalmológicas es de gran necesidad para el médico oftalmólogo y que estas requieren una atención multidisciplinaria para asegurar un seguimiento y tratamiento adecuado.

          Translated abstract

          Clinical Case: A 42-year-old man presented with ptosis and miosis in his left eye and a history of headache over the last 20 days. An angioresonance showed dissection of internal carotid artery. Discussion: "Painful Horner´s Syndrome" is considered to be a medical emergency due possible onset of an internal carotid artery dissection. We consider that awareness of neuro-ophthalmologic emergencies is very important in the clinical praxis of an ophthalmologist. Multidisciplinary treatment and follow-up of these patients is required.

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          Most cited references7

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          Transcranial Doppler in the evaluation of internal carotid artery dissection.

          A subject with dissection of the internal carotid artery (ICA) may present with a variety of symptoms, from headache to stroke. Thus far, it has not been possible to identify the subset of patients at risk for cerebral ischemia. Because the majority of these ischemic events are secondary to embolic phenomena, we used transcranial Doppler (TCD) evaluation with emboli monitoring to study 17 consecutive patients with ICA dissection treated at Harborview Medical Center, Seattle, Wash, during a 2-year period from 1992 until 1994. Ten patients with ICA dissection secondary to trauma and seven with spontaneous ICA dissection were diagnosed by carotid angiography and studied by TCD from the time of diagnosis through initiation of therapy. Emboli monitoring was performed in the middle cerebral artery (MCA) ipsilateral to the dissection at the initial evaluation and intermittently thereafter to ensure that the emboli stopped with treatment. Emboli were detected in the MCA distal to the dissection in 10 of 17 patients (59%). Patients with microemboli detected by TCD presented with a stroke (70%) much more frequently than those without emboli (14%) (P=.0498). The presence of a pseudoaneurysm did not increase the risk of either microemboli or stroke. We have demonstrated a high incidence of intracranial microemboli in the MCA distal to carotid dissections and a significant correlation between the presence of emboli and stroke. TCD can therefore be used as an adjunctive tool to manage patients with suspected carotid dissection and may prove useful in evaluating the efficacy of treatment in reducing microemboli and subsequent stroke.
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            Horner's syndrome: clinical and radiographic evaluation.

            Horner's syndrome (HS) occurs when there is interruption of the oculosympathetic pathway (OSP). This article reviews the anatomy of the OSP and clinical findings associated with lesions located at various positions along this pathway. The imaging findings of lesions associated with HS at various levels of the OSP, classified as preganglionic HS (first- and second-order neuron HS) or postganglionic HS (third-order neuron HS), are demonstrated.
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              Brief report: a familial syndrome of arterial dissections with lentiginosis.

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                aseo
                Archivos de la Sociedad Española de Oftalmología
                Arch Soc Esp Oftalmol
                Sociedad Española de Oftalmología (Madrid )
                0365-6691
                November 2011
                : 86
                : 11
                : 377-379
                Affiliations
                [1 ] Hospital Universitario La Fe Spain
                [2 ] Universitat de València Spain
                [3 ] Hospital 9 de Octubre
                [4 ] Universitat de València Spain
                Article
                S0365-66912011001100007
                10.1016/j.oftal.2011.06.007
                6b89ff9b-2163-442b-821f-48a4c6ac24e4

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                OPHTHALMOLOGY

                Ophthalmology & Optometry
                Carotid Artery, Internal, Dissection/complications,Carotid Artery, Internal, Dissection/diagnosis,Headache/aetiology,Horner Syndrome/pathophysiology,Sympathetic Ocular-Ophthalmoplegia,Disección arteria carótida interna/complicaciones,Disección arteria carótida interna/diagnóstico,Cefalea/etiología,Síndrome de Horner/fisiopatología,Oftalmoplejia simpática

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