Chiropractic sympathectomy: Carotid artery dissection with oculosympathetic palsy after chiropractic manipulation of the neck

The association between carotid artery dissection and oculosympathetic palsy is well-known. However, the occurence of this combination with chiropractic manipulation of the cervical neck is rare. We describe the case of a 54-year-old Caucasian American male who underwent cervical manipulation for neck pain. The following day he noticed drooping of his left eyelid, with an unequal pupil size. Imaging later confirmed carotid artery dissection. Only three previous cases (one from the United States), of an association between carotid artery dissection and chiropractic sympathectomy (oculosympathetic palsy after chiropractic manipulation of the neck) have been reported. Pictures of the oculosympathetic palsy, computed tomography of the head and magnetic resonance imaging of the dissection are presented.