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A 36-year-old man reported 4 weeks of left-sided headache and neck pain, with left miosis and ptosis. This had started during vigorous exercise, including abrupt cervical movements, and had been constant since. Six years before he had developed three episodes of numbness in the right arm and leg, each lasting around 15 min, thought to anxiety related. He had no cardiovascular risk factors or history of toxic intake. He had been treated for epilepsy from age 23, but had been seizure free for 11 years.
On examination, there was a left-sided Horner’s syndrome, comprising miosis and mild ptosis, but no other abnormalities. Laboratory testing and ECG were unremarkable.
MR scan of brain showed the parenchyma was normal, but MR cerebral angiogram showed the left cervical internal carotid artery had a narrowed eccentric lumen, with surrounding crescent-shaped mural thrombus, consistent with …
EMB-M and LMB are joint first authors.
Contributors EMB-M: literature search, manuscript drafting, sourced and selection of the images. LMB: literature search, manuscript drafting and facilitated the patient completing the consent form. BSG made the initial diagnosis, provided critical review and suggestions of the manuscript and the images. COG suggested the writing up of this case and made a critical review of the manuscript and the images. INV was in charge of the patient during hospitalisation, suggested the writing up of this case and provided critical review of the manuscript. MAGT was in charge of the patient during hospitalisation, suggested the writing up of this case and provided critical review of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned. Externally peer reviewed by Tom Moullaali, Edinburgh, UK, and Tom Hughes, Cardiff, UK.