Abstract：
We present a clinical situation where a 47-year old female patient consulted with left partial ptosis and miosis that started, two weeks before, with an episode of glandular fever secondary to Epstein-Barr infection. Apraclonidine 0.5% and Phenylephrine 1% drop testing was performed with results consistent with suspected left Horner Syndrome (HS), with a probable postganglionic location. Magnetic Resonance Angiography (MRA) at the moment of the acute presentation did not show any image suggesting carotid arterial dissection but showed irregular narrowing of the left internal carotid artery on its paravertebral extracranial way, consistent to enlarged intra-carotid sheath lymphoid tissue. A week later, a Doppler ultrasound was performed, showing bilateral images compatible with internal carotid arterial dissection. When Postganglionar HS is suspected, the first aetiology to rule out is a carotid arterial dissection because of its potentially fatal outcome and for being a more described entity as postganglionic HS aetiology. However, it is also evidenced that a certain diagnose is not always possible. Furthermore, we describe the enlarged internal carotid artery sheath lymphoid tissue as a possible cause of sympathetic nerve disruption causing a Postganglionar HS, although not common.
摘要：
我们提出了一种临床情况，其中一名47岁的女性患者开始咨询左部分下垂和瞳孔缩小，两周前，伴有继发于爱泼斯坦-巴尔感染的腺热。进行了0.5%的阿普洛尼定和1%的去氧肾上腺素滴落试验,结果与疑似左霍纳综合征(HS)一致。可能有节后位置。急性表现时磁共振血管造影（MRA）未显示任何提示颈动脉夹层的图像，但显示左侧颈内动脉椎旁颅外段不规则狭窄，与增大的颈动脉鞘淋巴样组织一致。一周后,进行了多普勒超声检查，显示与颈内动脉夹层相符的双侧图像。当怀疑神经节后HS时，首先要排除的病因是颈动脉夹层,因为其具有潜在的致命性结局,并且作为节后HS病因被更多地描述.然而,这也证明了一定的诊断并不总是可能的。此外，我们将扩大的颈内动脉鞘淋巴样组织描述为交感神经破坏的可能原因，引起节后HS，虽然不常见。
