Mehmet YORGUN, Osman TAŞ
Journal of Emergency Medicine Case Reports - 2026;17(1):1-3
Horner syndrome (HS) in the emergency department (ED) is never a trivial finding. While it often signals catastrophic vascular or neoplastic disease such as carotid dissection or apical lung cancer, spinal cavernous hemangioma (SCH) is an extraordinarily rare etiology. Its recognition is critical, as missing this subtle sign may delay life-saving intervention. We describe a 21-year-old previously healthy male who presented with acute neck pain, progressive right upper limb weakness, and contralateral lower limb paresthesia. Careful examination revealed right-sided ptosis and miosis, unveiling HS. Urgent cervical MRI demonstrated a 47 x 11 mm intradural lesion at C6-C7, consistent with a cavernous hemangioma. The patient underwent emergent microsurgical resection, resulting in rapid neurological recovery. By two months, all deficits-including HS-had completely resolved. This case underscores that even the most subtle ocular sign can reveal life-threatening spinal pathology in the ED. HS should be approached as a clinical alarm bell which that necessitates immediate imaging and multidisciplinary coordination. Recognizing SCH as a potential-though rare-culprit expands the emergency physician's diagnostic horizon and illustrates how prompt diagnosis and timely surgery can transform an impending catastrophe into full recovery.
