A 45-year-old woman presented with acute Horner syndrome associated with several weeks of midscapular pain radiating to the left upper extremity. The physical examination showed a left-sided Horner syndrome (Figure 1A) and signs of an ipsi-lateral radiculopathy of the first thoracic root with numbness and weakness in the Tl distribution. By computed tomography angiography, a dissection of the internal carotid artery was excluded. Spinal magnetic resonance imaging (MRI) demonstrated a pronounced disc herniation at the Tl-2 level (Figure IB and C). A laminoforaminotomy via a posterior approach was performed resulting in complete recovery.
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