Name
HORNER SYNDROME
DESCRIPTION
DETAIL
CAUSES : Interruption of the sympathetic nerve fi bers that originate in the hypothalamus and travel down to the lateral part of the brain stem to exit in the thoracic area. These fibers synapse in the cervical sympathetic ganglia and the postganglionic fibers travel to the eye along the wall of the carotid and ophthalmic arteries. - BRAIN STEM STROKE - CAROTID DISSECTION - NEOPLASM IMPINGING UPON SYMPATHETIC CHAIN - IDIOPATHICSPECIAL TESTS A normal pupil will dilate in response to installation of 10% cocaine. β’ The miotic pupil in Horner wonβt dilate, or will dilate poorly, because of the absence of norepinephrine at the nerve endings. β’ To distinguish a third order neuron disorder from a first and second neuron disorder 1% hydroxyamphetamine (Paredrine) or 4-hydroxyamphetamine 5% Pholedrine can be instilled 48 hours later. In a fi rst or second neuron lesion, dilation will take place. Failure of the Horner pupil to dilate, or poor dilatation indicates a third-order neuron lesion. IMAGING CT/MRI of the brain, chest, spinal cord DIAGNOSTIC PROCEDURES Spinal tap - occasionally indicated in addition to above
TYPENOTES
RISK FACTORS β’ Apical bronchogenic carcinoma (Pancoast tumor) β’ Aneurysm of the carotid or subclavian artery β’ Injuries to the carotid artery high in the neck β’ Congenital Horner syndrome β’ Dissection of the carotid arteries β’ Cluster headaches, approximately 20% of which have an accompanying ipsilateral Horner syndrome. The syndrome may outlast the headaches. β’ Carotid artery occlusion, approximately 15% of patients with carotid artery occlusion develop ipsilateral Horner syndrome - may occur without evidence of cerebral ischemia, neck injuries or operative procedures β’ Syringomyelia β’ Inflammatory process β’ Cervical nerve root avulsion GENERAL MEASURES β’ Search for tumor or other compressive lesion is indicated for any patient who develops Horner syndrome β’ Horner syndrome in itself does not produce any disability or require treatment β’ Treatment is management of the underlying condition DRUG(S) OF CHOICE Therapy appropriate for the underlying disease
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
BLEEDING TIME, CLOTTING TIME, CT SCAN HEAD, COMPLETE BLOOD COUNT, MRI HEAD & SPINE, CEREBRAL ANGIOGRAPHY