Clinical Practice and Cases in Emergency Medicine

Introduction: Internal carotid artery (ICA) dissection is a time-sensitive vascular emergency that may present with subtle findings, most notably painful Horner syndrome. Mechanical stress to the cervical vasculature is a recognized trigger for this condition.

Case Report: We report a 56-year-old man who developed ipsilateral ptosis, miosis, and head and neck pain after using a home cervical traction device. Computed tomography angiography showed focal critical stenosis of the distal cervical left ICA consistent with dissection, along with a contralateral pseudoaneurysm suggesting prior injury. He was treated with dual antiplatelet therapy.

Conclusion: This case highlights a potential association between cervical traction device use and carotid dissection and underscores the importance of recognizing painful Horner syndrome and bilateral carotid pathology, while prompting clinicians to specifically inquire about traction device use.