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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1809897
Case Report

Horner's Syndrome after Carotid Endarterectomy: A Case Report and Review of Literature

Nadeem Ahmed Siddiqui 
1   Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
,
Fatima Suleman 
1   Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
,
Shoaib Muhammad 
1   Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
,
Fareed Shaikh 
1   Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Funding None.
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Abstract

Horner's syndrome, characterized by ptosis, miosis, and anhidrosis, results from oculosympathetic complex injury, often due to trauma affecting the superior cervical ganglion. Although rare following carotid surgery, we present a case of Horner's syndrome after elective carotid endarterectomy (CEA). This report explores potential mechanism, including prolonged surgical retraction and hematoma formation, while reviewing similar cases in the literature. A 45-year-old woman presented with recurrent dizziness and progressive left-sided hearing impairment over 5 years. She also reported neck discomfort and experienced five episodes of amaurosis fugax in her left eye within 1 week. Computed tomography revealed occlusion of the right common and internal carotid artery (ICA), along with a 90% stenosis at the left common carotid bifurcation extending into the left ICA. Subsequently, an elective left CEA was performed. Within 24 hours postoperatively, she developed clinical signs of Horner's syndrome, including left-sided ptosis, miosis, anhidrosis, and concurrent facial nerve palsy. Notably, there was no evidence of hematoma formation or sensorimotor deficits. This case highlights the rare occurrence of Horner's syndrome as a postoperative complication of CEA. Surgeons should be mindful of anatomical variations and potential intraoperative mechanisms contributing to this complication to enhance prevention strategies. Recognizing this risk is essential for optimizing postoperative care and patient counseling.

Keywords

Horner's syndrome - carotid endarterectomy - postoperative complications

Authors' Contributions

N.S. was responsible for planning the manuscript, taking consent from the family, critically revising the manuscript and providing intellectual output, and giving final approval of the manuscript. F.S. was responsible for the preparation of the manuscript draft, adding pictures and table, and giving final approval of the manuscript. S.M. was responsible for the preparation of the case in the manuscript draft and giving final approval of the manuscript. F.S. was responsible for critically revising the manuscript, providing editorial input, and giving final approval of the manuscript.


Ethical Approval

Consent and institutional ethical approval have been obtained.




Publication History

Article published online:
25 June 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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