Orbital pain as an isolated sign of internal carotid artery dissection. A diagnostic pitfall

Head pain is one of the main presenting symptoms of internal carotid artery (ICA) dissection, usually in association with ischemic and/or local signs such as Homer's syndrome lower cranial nerve palsies, or tinnitus. In rare cases, head pain remains isolated and mimics other conditions. We report a patient who suffered isolated prolonged orbital pain as the only sign of intrapetrous ICA dissection. Early recognition of such unusual facial gain may be crucial in decreasing the risk of secondary cerebral or retinal ischemia.