A small left pupil and a headache

Abstract

Carotid artery dissection is an important cause of stroke in young adults. When focal neurological deficit or classic traumatic history is absent, the diagnosis can be challenging. This lesson reports an interesting case of a patient in whom pupillary dysfunction was the presenting sign of acute dissection of carotid artery.

Fig 1.

Magnetic resonance angiography of aortic arch and carotids. A dissecting aneurysm arising from the left internal carotid artery is demonstrated measuring 13 mm in length with a narrow neck of 2 mm.

Fig 2.

Volume rendered image from follow up CT angiography examination showing pseudoaneurysm of left internal carotid artery. The study was undertaken a month after his initial presentation and shows evolution of the dissection to pseudoaneurysm. Resolution was achieved three months later on anti-coagulation.