Horner's syndrome and dissection of the internal carotid artery after chiropractic manipulation of the neck

PURPOSE: To report a case of Horner's syndrome and dissection of the intern al carotid artery after chiropractic manipulation of the neck. METHODS: Case report. A 44-year-old woman with no prior ocular or vascular history presented with severe right-sided head and neck pain, ptosis, and m iosis following chiropractic treatment for a strained right shoulder muscle . RESULTS: Magnetic resonance angiography of the neck and brain revealed a di ssection of the right internal carotid artery as well as a suggestion of su btle dissection in the right vertebral artery. No significant brain abnorma lities were noted on magnetic resonance imaging. Pharmacological testing wa s consistent with preganglionic oculosympathetic damage. CONCLUSION: Acute, painful Horner's syndrome as a manifestation of vascular dissection may be associated with chiropractic manipulation of the neck. ( Am J Ophthalmol 2001;131:523-524. (C) 2001 by Elsevier Science Inc. All rig hts reserved).