Abstract Details

Title Transient Perivascular Inflammation of the Carotid Artery (TIPIC): A rare cause of Horner’s Syndrome

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-023

Objective Describe a case of Horner’s Syndrome caused by rare diagnosis of TIPIC

Background Transient Perivascular Inflammation of the Carotid Artery (TIPIC) Syndrome is a rare cause of atypical neck pain[1] and relatively recently identified as an individual clinical entity[2]. This is the first case we know of TIPIC causing a Horner’s syndrome (partial ptosis, miosis and anhidrosis)[3]. The patient was a 44yo M who presented with 3 days of new headache, aural fullness and a right sided Horner’s syndrome. He had a CTA head/neck and was found to have diffuse thickening of the cervical right ICA wall. His inflammatory markers were unremarkable, he had no systemic signs or symptoms. Rheumatology was consulted for evaluation of arteritis, with low suspicion given his lack of other symptoms. Extensive lab evaluation of infectious and inflammatory conditions was sent which was negative. His MRA neck (black blood) was notable for multifocal perivascular edema and enhancement of the right cervical ICA, with mild luminal irregularity, consistent with a diagnosis of TIPIC. Though the pathophysiology of TIPIC is not well understood, it is typically a self limiting pathology and often responds to NASIDs or steroids[4]. Patient was started on a 14 day course of naproxen with improvement in his headaches.

[1] 1. Lecler, A, Obadia, M, Savatovsky, J, et al. TIPIC Syndrome: Beyond the Myth of Carotidynia, a New Distinct Unclassified Entity. AJNR Am J Neuroradiol. 2017. July; 38(7): 1391–1398. Epub 2017 May 11 DOI: 10.3174/ajnr.A5214

[3] Zalan Khan Horner’s Syndrome. https://www.ncbi.nlm.nih.gov/books/NBK500000/

Design/Methods N/A

Results N/A

Conclusions This case exemplifies a rare cause of a Horner’s syndrome from TIPIC, with a high degree of clinical suspicion necessary for the diagnosis.

Authors/Disclosures
Elizabeth Celente, DO (Tripler Army Medical Center) PRESENTER	Dr. Celente has nothing to disclose.
Mary Higginson, MD	Dr. Coughlin has nothing to disclose.
Cole P. Denkensohn, MD (LRMC)	Dr. Denkensohn has nothing to disclose.

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