We report the case of a young man who presented with headache and Horner's syndrome. Investigations confirmed spontaneous carotid dissection. This case reminds of a rare but significant cause of stroke in the young. Case Report A 38 year old man presented with a 1 week history of right sided throbbing headache, gradual in onset and not associated with visual symptoms. The headache had no diurnal variation, was not associated with premonitory symptoms, fever or vomiting. There were no known precipitating factors and no history of trauma. His wife also mentioned that his right eye looked funny. There was no associated limb weakness or sensory symptoms. He was started on Sumatriptan by the general practitioner as he was diagnosed to have migraine in the past. There was no other past medical history.On examination, he was afebrile, his blood pressure. was 130/80 mm Hg and pulse was 72 per minute, regular. He had partial ptosis of his right eye, conjunctival congestion and meiosis. His fundoscopy, visual acuity and eye movements were normal The rest of his neurological examination was normal. There was no carotid bruit. There were no signs of meningism nor a rash. Examination of his cardiovascular, respiratory gastrointestinal systems was entirely normal. Blood tests showed a normal haemogram, renal profile, CRP and coagulation studies. His electrocardiogram and chest X ray were within normal limits.CT Brain showed a small peripheral area of low attenuation in the right temporal lobe which raised the possibility of ischaemia (Figure 1). An urgent MRI brain showed a crescent shaped area (arrowed) of high signal representing a clot within false lumen of right internal carotid artery. (Figure 2)
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