an abrupt and a very severe headache associated with unilateral pulsatile tinnitus

Q: 74 year old man presented to the ED with a complaint of an abrupt and a very severe headache associated with unilateral pulsatile tinnitus and hypogeusia. On examination, the patient found to have a Horner syndrome. What is the suspected diagnosis? 


Answer: Dissection of the ipsilateral internal carotid artery

Patients with carotid artery dissection can have a variety of presentations from minor to dramatic symptoms. It can occur in any age group but more in the younger age group. Few clues to the dissection of the internal carotid artery include a headache associated with neck and face pain, amaurosis fugax, Horner syndrome, Pulsatile tinnitus, hypogeusia and sometimes deceiving migraine-like symptoms.

#neurology


Reference:

 Divjak I, Slankamenac P, Jovicevic M, Zikic TR, Prokin AL, Jovanovic A. A case series of 22 patients with internal carotid artery dissection. Med Pregl. 2011 Nov-Dec. 64(11-12):575-8.