Delayed Horner's syndrome and acute stress disorder caused by a large dog bite on the neck: Case report

Rationale:The occurrence of delayed Horner's syndrome caused by a dog bite to the neck is rarely reported. Acute stress disorder (ASD) can easily be neglected when diagnosing this disease in trauma patients who cannot be effectively observed. The symptoms of Horner's syndrome may not be readily detected in patients with ASD.Patient concerns:In this report, we present a rare case of a 55-year-old woman with delayed Horner's syndrome and ASD who initially presented with an internal jugular vein injury caused by a large dog bite on her left neck.Diagnosis:Delayed Horner's syndrome and ASD.Interventions:Neck exploration and internal jugular vein repair were performed under general anesthesia. After the occurrence of Horner's syndrome and ASD, methylprednisolone and mecobalamin were administered to relieve edema and promote nerve repair, compound anisodine was injected once daily near the left superficial temporal artery to improve microcirculation, escitalopram oxalate and lorazepam were administered to treat anxiety and improve sleep, psychotherapy and narrative nursing were administered once a week.Outcomes:In the follow-up 4 months at the outpatient clinic after discharge, the patient's Horner's syndrome had not healed, but she did not complain of significant discomfort and affected appearance, and ASD did not recur or develop post-traumatic stress disorder.Lessons:Surgeons should be aware of the possibility of sympathetic nerve injury in patients with deep neck injury, especially in patients with internal jugular vein injury. Peripheral nerves should be explored during the operation. Attention should be paid to the possibility of delayed neurological symptoms and the prevention and treatment of ASD after operation.