Clinical import of Horner syndrome in internal carotid and vertebral artery dissection

Objective: To study the prognostic importance of Horner syndrome (HS) in patients with internal carotid artery dissection (ICAD) or vertebral artery dissection (VAD).

Methods: In this observational study, characteristics and outcome of patients with ICAD or VAD from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) database were analyzed. The presence of HS was systematically assessed using a standardized questionnaire. Patients with HS (HS+) were compared with HS− patients. Crude odds ratios (ORs) with 95% confidence intervals and ORs adjusted for age, sex, center, arterial occlusion, bilateral dissection, stroke severity, and type of antithrombotic treatment were calculated.

Results: We analyzed 765 patients (n = 496 with ICAD, n = 269 with VAD, n = 303 prospective, n = 462 retrospective). HS was present in 191 (38.5%) of the patients with ICAD and 36 (13.4%) of the patients with VAD (p < 0.001). HS+ ICAD patients presented less often with stroke or TIA (p < 0.001), less often had bilateral (p = 0.019) or occlusive (p = 0.001) dissections, and had fewer severe strokes (p = 0.041) than HS− ICAD patients. HS+ ICAD patients had a better functional 3-month outcome than those without HS (OR_crude = 4.0 [2.4–6.7]), and also after adjustment for outcome-relevant covariates (OR_adjusted = 2.0 [1.1–4.0]). HS+ ICAD patients were less likely to have new strokes than HS− ICAD patients (p = 0.039). HS+ VAD patients more often had vessel occlusion (p = 0.014) than HS− patients but did not differ in any of the other aforementioned variables.

Conclusion: In patients with ICAD, HS is an easily assessable marker that might indicate a more benign clinical course. HS had no prognostic meaning in patients with VAD.