Teaching NeuroImages: Thermal imaging in Horner syndrome

A 50-year-old woman with a history of fibromuscular dysplasia presented to the emergency department with 1 day of right ear pain. Examination demonstrated 2 mm anisocoria, left pupil larger than right, with brisk pupillary light reactions bilaterally; 2.5 mm right ptosis; and anhidrosis of the right forehead, as determined by the spoon test. Thermal imaging was consistent with this finding (figure). She was diagnosed with acute, painful Horner syndrome. MRI/magnetic resonance angiography demonstrated right internal carotid artery dissection. Due to the risk of stroke immediately following internal carotid dissection,¹ she was treated with heparin drip, then later transitioned to aspirin and clopidogrel therapy.²

from Neurology recent issues https://ift.tt/2mTrInj