Painful oculosympathetic palsy as the sole presentation of spontaneous dissection of the distal internal carotid artery

Spontaneous dissection of the carotid artery is an important differential diagnosis to consider in cases of early onset stroke. Its natural history is variable, ranging from a benign course to permanent disability or death. Dissection usually occurs in the cervical portion of the artery, rendering it amenable to surgical therapy. These issues are compounded if there is intrapetral extension, with associated mortality rates up to 75%. The authors describe such a case of spontaneous dissection and discuss imaging and therapy issues that result.