Unusual presentation of more common disease/injury Fell off of a horse – journey from Emergency Department to Stroke clinic

The authors present a case of a young woman who presented with transient episodes of left-sided weakness after she fell off a horse. She attended Emergency Department twice before being referred to the Stroke clinic, where she was diagnosed with carotid artery dissection. BACKGROUND Emergency physicians should consider the possibility of arterial dissection in any trauma patient with headache or neurological signs, when consideration of common causes fails to lead to a diagnosis. Awareness of its clinical features and advances in imaging in recent times can lead to earlier detection of this condition. Failure to suspect a dissection in minor injury can lead to permanent neurological deficits. Traumatic injury to the major vessels of the head and neck can result in potentially devastating neurological sequelae.1 Traumatic carotid dissection occurs in approxi-mately 1%of all patientswith blunt injurymechanisms and is frequently initially unrecognised.2 Cervical dissectio