19th February 2024

A 43-year-old female presents with a severe headache and neck pain that has arisen over the past 24 hours.

A 43-year-old female presents with a severe headache and neck pain that has arisen over the past 24 hours. This was localised around her temples, cheeks and left neck. This was accompanied by ptosis of her left eye. She also experienced a pulsatile ringing noise in her ears since the onset of her headache. Examination reveals a miosis of her left eye. Anhidrosis is not noted.  

She had recently attended her chiropractor and had her neck manipulated but denies any trauma.   

Given the clinical findings, what is the likely cause for the patient’s Horner’s syndrome?