Horner's syndrome

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Horner’s syndrome is a clinical syndrome caused by damage to the sympathetic nervous system.

It is named after Johann Friedrich Horner, the Swiss ophthalmologist who first described the syndrome in 1869.^[1][2] Several others had previously described cases, but “Horner’s syndrome” is most prevalent. In France, Claude Bernard is also eponymised with the condition being called “syndrome Bernard-Horner”.

It is important to distinguish the ptosis caused by Horner’s syndrome from the ptosis caused by a lesion to the oculomotor nerve. In the former, the ptosis occurs with a constricted pupil (due to a loss of sympathetics to the eye), whereas in the latter, the ptosis occurs with a dilated pupil (due to a loss of innervation to the sphincter pupillae). In an actual clinical setting, however, these two different ptoses are fairly easy to distinguish. In addition to the blown pupil in a CN III (oculomotor nerve) lesion, this ptosis is much more severe, occasionally occluding the whole eye. The ptosis of Horner’s syndrome can be quite mild or barely noticeable.

There are no direct complications of Horner’s syndrome itself. However, there may be complications from the disease that caused Horner’s syndrome or from its treatment. The outcome depends on whether treatment of the cause is successful.

An eye examination may show changes in how the pupil opens or closes and eyelid drooping. A complete medical and nervous system (neurological) examination can show whether any other parts of the body are affected.

Treatment depends on the cause of the problem. There is no treatment for Horner’s syndrome itself.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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It is named after Johann Friedrich Horner, the Swiss ophthalmologist who first described the syndrome in 1869.^[1][2] Several others had previously described cases, but “Horner’s syndrome” is most prevalent. In France, Claude Bernard is also eponymised with the condition being called “syndrome Bernard-Horner”.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Horner’s syndrome is due to a deficiency of sympathetic activity. The site of lesion to the sympathetic outflow is on the ipsilateral side of the symptoms. The following are examples of conditions that cause the clinical appearance of Horner’s syndrome:

• First-order neuron disorder: Central lesions that involve the hypothalamospinal pathway (e.g. transection of the cervical spinal cord).
• Second-order neuron disorder: Preganglionic lesions (e.g. compression of the sympathetic chain by a lung tumor).
• Third-order neuron disorder: Postganglionic lesions at the level of the internal carotid artery (e.g. a tumor in the cavernous sinus).

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Horner’s syndrome is usually acquired but may also be congenital (inborn) or iatrogenic (caused by medical treatment). Although most causes are relatively benign, Horner’s syndrome may reflect serious pathology in the neck or chest (such as a Pancoast tumor or thyrocervical venous dilatation) and hence requires workup.

• Due to lesion of one side of the cervical sympathetic chain which affects on the same side of the lesion
• PICA syndrome
• Cluster headache – combination termed Horton’s headache^[1]
• Trauma – base of neck, usually blunt trauma.
• Middle ear infection
• Tumors – often bronchogenic carcinoma of the superior fissure (Pancoast tumor)
• Thoracic aortic aneurysm
• Neurofibromatosis type 1
• Goitre
• Dissecting aortic aneurysm
• Thyroid carcinoma
• Multiple sclerosis
• Carotid artery dissection
• Klumpke paralysis
• Cavernous sinus thrombosis
• Sympathectomy
• Syringomyelia
• Nerve blocks, such as cervical plexus block, stellate ganglion or interscalene block
• Brainstem stroke
• Carotid body tumor
• Lymphoma
• Mediastinal mass
• Metastasis
• Parotid gland tumor
• Tuberculosis adenitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please help WikiDoc by adding more content here. It’s easy! Click here to learn about editing.

It is important to distinguish the ptosis caused by Horner’s syndrome from the ptosis caused by a lesion to the oculomotor nerve. In the former, the ptosis occurs with a constricted pupil (due to a loss of sympathetics to the eye), whereas in the latter, the ptosis occurs with a dilated pupil (due to a loss of innervation to the sphincter pupillae). In an actual clinical setting, however, these two different ptoses are fairly easy to distinguish. In addition to the blown pupil in a CN III (oculomotor nerve) lesion, this ptosis is much more severe, occasionally occluding the whole eye. The ptosis of Horner’s syndrome can be quite mild or barely noticeable.

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Please help WikiDoc by adding content here. It’s easy! Click here to learn about editing.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please help WikiDoc by adding more content here. It’s easy! Click here to learn about editing.

There are no direct complications of Horner’s syndrome itself. However, there may be complications from the disease that caused Horner’s syndrome or from its treatment. The outcome depends on whether treatment of the cause is successful.

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