I thank Furlan and Sundaram1 for their interesting case report on a patient who experienced a carotid artery dissection and subsequent Horner syndrome from coughing. I would like to remind clinicians that such a post-tussive injury should prompt consideration of pertussis as an underlying cause.
The cough caused by Bordetella pertussis infection is especially violent and can cause a variety of post-tussive injuries. Carotid artery dissection as a complication of pertussis has previously been reported.2 Other potential symptoms and injuries secondary to pertussis include prolonged cough, seizures, syncope, encephalopathy, urinary incontinence, rib fracture, pneumothorax, inguinal hernia, subconjunctival hemorrhage, hearing loss and lumbar disc herniation.2 In my emergency medicine practice, I have also seen pertussis cause vocal cord dysfunction, post-tussive vomiting and valsalva retinopathy.
The incidence of pertussis has been increasing since 1990.3 We must remain vigilant for it in cases of unusual injury secondary to coughing.
References
- 1.Furlan JC, Sundaram ANE. Sudden-onset anisocoria in a patient with upper respiratory tract infection. CMAJ 2014;186:57–61 [DOI] [PMC free article] [PubMed] [Google Scholar]
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