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Sir,

We were grateful for the interest in our case report regarding a patient who developed Horner's syndrome postpartum. The ‘high’ forceps delivery was an editorial oversight on our part which should read ‘outlet’ forceps. The unreferenced postulation that our patient may have developed spontaneous thrombosis of her internal carotid artery is an interesting notion that does not find sufficient purchase here. Magnetic resonance angiography demonstrated an entirely different aetiology, that of dissection throughout the length of the vessel, as clearly stated in our report. This is difficult to ignore.

Carotid dissections have been reported in a variety of situations such as minor trauma,1 sneezing,2 coughing,3 attendance at the hairdressers4 and kite-flying5 in patients without other risk factors for dissection. While there is no proof that a difficult delivery is responsible for our patient's dissection, it is a possibility that has more credence than spontaneous thrombosis of the carotid artery. Once again, we emphasise the value of good magnetic resonance angiography in diagnosing dissection of the major arteries.

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