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Spontaneous cervical artery dissection (sCAD) is one of the main causes of ischemic stroke in young adults. Local symptoms (LSs) are common in sCAD and often predate ischemic events, yet little is known about their frequency and prognosis. Consecutive patients with sCAD admitted to the Medical University of Innsbruck between July 1996 and January 2017 were included in this study. The diagnosis of sCAD was obligatorily confirmed by magnetic resonance imaging (MRI) documentation of the intramural hematoma in T1-weighted fat-saturated sequences. Cases of CAD that occurred spontaneously or following minimal trauma, for example hyperextension, rotation or lateroversion of the neck, were eligible for our study. Patients with high impact trauma with signs of external or internal injury other than CAD, and patients with intracranial artery dissection were excluded from this analysis. The electronic medical records of all eligible patients, including discharge, imaging, and outpatient reports, were carefully reviewed with a focus on the frequency, presentation, duration, and long term outcome of LSs. Clinical evaluation of the data was done by an experienced stroke physician. Head/neck pain, Horner’s syndrome, lower cranial nerve palsy (IX through XII, isolated or combined), and tinnitus, caused by local mass effect of the dissected vessel on the surrounding tissue, were considered as LSs. All sCAD patients were invited to an extensive standardized follow-up visit within our ReSect-Study, a single centre cohort study investigating possible risk factors for recurrent sCAD. The study was approved by local ethics committee and all participants signed appropriate consent forms. A total of 259 patients with MRI-confirmed sCAD were enrolled. The median follow-up was 6.0 years (interquartile range [IQR], 6.0; minimum 0.8 to maximum 20.3). No in person follow-up or follow-up records were available in only five patients. In our cohort, males predominated (59.8%). The median age at onset was 44.4 years (IQR, 14.8; minimum 21 to maximum 87). At symptom onset, men were older than women (median, 47.4 years [IQR, 14.0] and 40.5 [IQR, 13.1], P<0.001). A total of 190 subjects of our cohort suffered ischemic stroke/transient ischemic attack (73.4%) (Table 1). LSs were evident in 212 of the 259 sCAD patients (81.9%) with head/neck pain being the most frequent (n=205, 79.2%), followed by Horner’s syndrome (n=42, 16.2%), tinnitus (n=19, 7.3%), and lower cranial nerve palsy (n=13, 5.0%). Multiple LSs were seen in 61 of 259 patients (23.6%). Headache was the only LS that was present in all patients with multiple LSs and head/ neck pain combined with Horner’s syndrome was the most common combination of symptoms (34 of 61, 55.7%). In all of the cases with cranial nerve palsy, an expansive pseudo-aneurysm was evident. None of our patients had complaints suggestive of cervical nerve root compression. Head/neck pain relieved within a median of 13.5 days (IQR, 12) and all patients with cranial nerve palsy or tinnitus had full spontaneous remission (maximum duration 5 and 3 months, respectively). Horner’s syndrome Local Signs and Symptoms in Spontaneous Cervical Artery Dissection: A Single Centre Cohort Study