Clinical Reasoning: Partial Horner syndrome and upper right limb symptoms following chiropractic manipulation.

SECTION 1 A 60-year-old man with no medical history was admitted to the Department of Neurology with drooping of his right upper eyelid and an ipsilateral contracted pupil, combined with pain, weakness, and numbness in his upper right limb. The patient had experienced thoracic back pain of moderate intensity with radiating right-sided belt-like chest pain for 7 days when the discomfort suddenly intensified, causing him to seek chiropractic treatment. Following manipulations of the thoracic and cervical spine, the pain intensity initially lessened. Approximately 1 hour after chiropractic treatment, the patient experienced onset of the eye and upper limb symptoms described above, for which he sought medical assistance 3 days later. No other symptoms were present at any time.