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Kraker JA, Tajfirouz DA, Bhatti MT, Chen JJ. Tachyphylaxis With Sustained Apraclonidine Use in the Treatment of Ptosis Associated With Horner Syndrome. J Neuroophthalmol 2023; 43:e245-e246. [PMID: 36279499 DOI: 10.1097/wno.0000000000001611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jessica A Kraker
- Mayo Clinic Department of Ophthalmology (JAK, DAT, MTB, JJC), Rochester, Minnesota; and Mayo Clinic Department of Neurology (MTB, JJC), Rochester, Minnesota
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Zwueste DM, Grahn BH. A review of Horner's syndrome in small animals. Can Vet J 2019; 60:81-88. [PMID: 30651655 PMCID: PMC6294019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Horner's syndrome arises from dysfunction of the oculosympathetic pathway and is characterized by miosis, enophthalmos, protrusion of the third eyelid, and ptosis. It has been recognized in a wide variety of breeds and ages in small animal patients. The oculosympathetic pathway is a 3-neuron pathway. The central/first order neuron arises from the hypothalamus and extends down the spinal cord. The preganglionic/second order neuron arises from the first 3 thoracic spinal cord segments and travels through the thorax and cervical region until it synapses at the cranial cervical ganglion. The postganglionic/third order neuron travels from this ganglion to the orbit. Topical application of cocaine is the gold standard for differentiating Horner's syndrome from other causes of miosis. Topical 1% phenylephrine allows for identification of a post-ganglion Horner's syndrome. Numerous etiologies have been reported for Horner's syndrome, but idiopathic disease is most common. Ancillary diagnostics include otoscopic examination, thoracic radiographs, or advanced imaging. Treatment and prognosis are determined by the etiology.
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Affiliation(s)
- Danielle M Zwueste
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B4
| | - Bruce H Grahn
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B4
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Abstract
RATIONALE Horner's syndrome (HS) can present as a complication of thyroid surgery, particularly after thyroid microwave ablation (MWA). HS presents clinically with eyelid ptosis, miosis, enophthalmos, anhidrosis, and vascular dilatation, all of which result from a damaged oculosympathetic chain. We aimed to try to avoid such devastating symptoms in future cases by exploring reasons for the destruction of the cervical sympathetic trunk. PATIENT CONCERNS HS has previously been reported in the literature as a complication of thyroid surgery. Here, we report the case of a 44-year-old female patient who presented with miosis and eyelid ptosis following thyroid MWA. DIAGNOSES This patient was subsequently diagnosed with HS. INTERVENTIONS Mecobalamin was administered immediately. OUTCOMES After 5 months of follow up, the patient's miosis and ptosis was incompletely relieved. LESSONS Although HS is a rare complication of thyroid MWA, surgeons must be aware of the anatomic relationship of the cervical sympathetic trunk and thyroid gland with adjacent structures. Moreover, we hope this case presentation enables surgeons to take measures to minimize the possibility of oculosympathetic damage. Long-term follow up and comprehensive assessments are important for the patient's prognosis.
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Affiliation(s)
- Xi Zhang
- Department of Thyroid Surgery, First Hospital of Jilin University
| | - Yunhao Ge
- Department of Neurology, People's Hospital of Changchun City, Jilin, China
| | - Peiyou Ren
- Department of Thyroid Surgery, First Hospital of Jilin University
| | - Jia Liu
- Department of Thyroid Surgery, First Hospital of Jilin University
| | - Guang Chen
- Department of Thyroid Surgery, First Hospital of Jilin University
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Abstract
RATIONALE Horner syndrome is an unusual complication after thyroidectomy. PATIENT CONCERNS We report a case of Horner syndrome in a 34-year-old female patient with Graves disease associated with papillary thyroid carcinoma who underwent left-side minimally invasive video-assisted thyroidectomy and neck dissection. DIAGNOSIS Horner syndrome was diagnosed based on left myosis, eyelid ptosis, and mild enophthalmos, which developed in the patient on postoperative day 2. INTERVENTIONS The patient was administered glucocorticoids and neurotrophic drugs on postoperative day 3. OUTCOME The symptoms of Horner syndrome were significantly relieved 1 year later. LESSONS Surgeons must be aware that Horner syndrome may be a source of iatrogenic complications, and patients also should be informed of these complications before surgery.
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Affiliation(s)
| | | | | | - Dajun Yu
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui, China
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Karadžić J, Kovačević I, Ljikar J. The role of apraclonidine in Horner’s syndrome – A case report. SRP ARK CELOK LEK 2016; 144:312-314. [PMID: 29648752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Horner’s syndrome is an interruption of the sympathetic nervous system at any point along its course between the hypothalamus and the orbit. Horner’s syndrome is classically presented as an ipsilateral miosis, subtle ptosis, and facial anhidrosis. Pharmacologic testing is very useful in the diagnosis of Horner’s syndrome as it could help to localize the lesioned neuron in the sympathetic pathway, suggesting an etiology. CASE OUTLINE We present a case report of a 41-year-old woman who reported right eyelid drooping immediately after operation of sympathetic chain schwannoma. We performed apraclonidine test for the diagnosis of Horner’s syndrome, which produced mydriasis on the affected eye, while there was no significant change of the normal eye. Based on the clinical presentation of anisocoria and one-sided ptosis, and previous medical history of surgical removal of the mediastinal tumor, the patient was diagnosed with a right-sided, partial Horner’s syndrome. CONCLUSION Timely recognition, exact localization of the lesioned neuron, and referral for urgent imaging studies are important for ophthalmologists in order to prevent and treat life-threatening conditions. Besides its diagnostic value in Horner’s syndrome, topical apraclonidine could correct ptosis for the sake of esthetics or when ptosis reduces the superior visual field.
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Elmgreen SB. [A rare case of Horner's syndrome in pituitary apoplexy]. Ugeskr Laeger 2015; 177:80-81. [PMID: 25612979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pituitary apoplexy is a rare but potentially life-threatening condition that is classically comprised of acute-onset severe headache accompanied by nausea and vomiting, visual field disturbances, external ophthalmoplegia, and often hypopituitarism. A case illustrating the highly variable clinical appearance of this condition is presented.
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Affiliation(s)
- Søren Bruno Elmgreen
- Neurofysiologisk Afdeling, Aarhus Universitetshospital, Nørrebrogade 44, 8000 Aarhus C.
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Ilcus LS. You're the flight surgeon: Horner's syndrome and carotid artery dissection. ACTA ACUST UNITED AC 2013; 84:879-82. [PMID: 23926669 DOI: 10.3357/asem.3636.2013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Schöffel N, Opitz C, Groneberg DA, Spencker S. [Atrial fibrillation and Horner syndrome. How one leads to another]. MMW Fortschr Med 2013; 155:4. [PMID: 23700685 DOI: 10.1007/s15006-013-0314-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- N Schöffel
- DRK Kliniken Berlin-Köpenick, Klinik für Kardiologie, Salvador-Allende- Strasse 2-8, D-12559 Berlin
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Fountaine TJ, Miller B, Khalifa YM, Andolina JR. Horner syndrome in a newly diagnosed patient with high risk precursor B-cell acute lymphoblastic leukemia. Pediatr Blood Cancer 2012; 59:344. [PMID: 22232083 DOI: 10.1002/pbc.24062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/02/2011] [Indexed: 11/06/2022]
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Pirouzian A, Holz HA, Ip KC, Sudesh R. Acquired infantile Horner syndrome and spontaneous internal carotid artery dissection: a case report and review of literature. J AAPOS 2010; 14:172-4. [PMID: 20451860 DOI: 10.1016/j.jaapos.2009.12.169] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 12/30/2009] [Accepted: 12/31/2009] [Indexed: 11/18/2022]
Abstract
Horner syndrome, a triad of ptosis, anisocoria, and anhidrosis, results from interruption in the oculosympathetic pathway. It is classically described as either congenital or acquired to depict its underlying pathophysiology and requisite work-up. We report a case of a 10-month-old infant presenting with an acute onset of left Horner syndrome secondary to a spontaneous extracranial internal carotid artery dissection. To the best of our knowledge, this is the first case report in the literature of acute onset of acquired infantile Horner syndrome in association with spontaneous carotid artery dissection confirmed with magnetic resonance angiogram.
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Affiliation(s)
- Amir Pirouzian
- Kaiser Permanente Medical Group, Santa Clara, California, USA.
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Raza SN, Rahat ZM. Horner's syndrome as a co-presentation of tuberculous retropharyngeal abscess. J Coll Physicians Surg Pak 2010; 20:279-281. [PMID: 20392409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 12/09/2009] [Indexed: 05/29/2023]
Abstract
Tuberculosis is a disease known to affect any part of the body and to present in many interesting forms. A case of tuberculous retropharyngeal abscess is described here presenting with odynophagia and Horner's syndrome. Horner's syndrome as a presenting feature of tuberculous retropharyngeal abscess has never been reported in Pakistan.
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Kobayashi Y, Yamamoto T. [Case of Horner's syndrome associated with ophthalmic herpes zoster]. Rinsho Shinkeigaku 2007; 47:105-8. [PMID: 17511278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
We reported a 74-year-old man with right Horner's syndrome associated with ophthalmic herpes zoster. He presented acute onset of pain, swelling, vesicular cutaneous eruption around the right eyelid. A diagnosis of herpes zoster ophthalmicus was made and he was started on acyclovir 750 mg/day. Seven days later he manifested right abduction deficit On admission nine days later, the right eyelid became ptotic and the right pupil was smaller than the left There was gradual improvement over the next 10 days in ptosis and miosis, and over the next 3 weeks in the right abduction deficit. As the sympathetic nerve runs with the carotid artery, it partially joins the sixth nerve within the cavernous sinus. We have identified a patient in whom herpes zoster ophthalmicus has resulted in a syndrome involving the sympathetic nerves, the sixth nerve, and the first division of the fifth cranial nerve. As the Horner's syndrome was transient, we might miss the symptom in the early stage, so we should carefully examine the patients.
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Abstract
We describe a delayed case of Horner's syndrome after the use of a peripherally inserted central line. Central vein thrombosis, a well-recognized complication of central venous access, led to temporary injury to the sympathetic tract in the neck. Presentation of Horner's syndrome with central venous access in place should be further investigated to rule out central vein thrombosis.
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Affiliation(s)
- A Y Gancz
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1, Canada
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Straetmans J, Lok W, Stokroos R. Horner's syndrome as a complication of acute otitis media. B-ENT 2006; 2:181-4. [PMID: 17256405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
A seventeen-year-old girl presented with acute otitis media, unilateral miosis and ptosis (partial Horner's syndrome) and tenderness of the ipsilateral jugular vein. A culture of the otorrhoea showed Staphylococcus aureus and Streptococcus pyogenes. A CT scan revealed an infiltrate near the ipsilateral carotid artery and jugular vein. The patient was hospitalised and treated with antibiotics. Clinical signs disappeared within 6 days. This report discusses the first case with a partial Horner's syndrome as an unusual complication of acute otitis media (AOM). Imaging studies suggest extracranial lymphatic spread of the infection along the adjacent jugular vein causing pressure on the postsynaptic sympathetic fibres. Recognition of the Horner's syndrome is of importance because it may be an early sign of an extracranial complication of AOM.
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Affiliation(s)
- J Straetmans
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Maastricht, The Netherlands
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Abstract
Due to the complex neuroanatomy of the sympatho-excitatory pathway, Horner's syndrome represents a clinical sign that may result from a variety of lesions in the central and peripheral nervous system. The purpose of the present communication is to help the reader to localize the site of the lesion and to demonstrate the most common etiologic mechanisms resulting in Horner's syndrome. The functional anatomy of the sympathetic supply to the iris, eyelids, facial sweat glands and blood vessels is reviewed and in particular the structure of the central pathway updated. Moreover, pharmacological testing and tests of sudomotor function are described that may help to guide the decision regarding useful additional diagnostic, especially neuroimaging procedures. Finally, a schematic overview is given on the most common pathology, considering additional clinical signs and symptoms.
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Affiliation(s)
- J J Marx
- Klinik und Poliklinik für Neurologie, Johannes Gutenberg Universität Mainz.
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Abstract
A 47-year-old woman presented with headache, acute monocular vision loss, and ipsilateral Horner syndrome. Apart from the optic neuropathy, all cranial nerve function was intact. Magnetic resonance imaging revealed an enlarged pituitary gland with compression of the orbital apex. The surgical specimen was consistent with pituitary apoplexy. The combination of headache, acute visual loss, and ipsilateral Horner syndrome without ophthalmoplegia, which may suggest carotid artery dissection, is evidently an unusual manifestation of pituitary apoplexy.
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Affiliation(s)
- Robert K Shin
- Department of Neurology and Ophthalmology, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Jimenez Caballero PE, Garcia Montero MR. [Deferred Horner syndrome following thoracoplasty]. Rev Neurol 2003; 36:935-7. [PMID: 12766867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Horner syndrome (HS) involves an injury affecting the ocular sympathetic nerve, which gives rise to myosis, palpebral ptosis and enophthalmos, and is accompanied by hemifacial anhidrosis in its complete forms. Its extension means that its involvement can occur in different structures and as a result of different medical and surgical processes. CASE REPORT We describe the case of two patients who developed a subacute form of HS without involvement of the sweating process and which was not accompanied by any other clinical features affecting the orbit, neck, brain, spinal cord or of a radicular nature. Both of them had been submitted to thoracoplasty as therapy for tuberculosis over 30 years earlier. The complementary studies that were conducted did not reveal involvement of the ocular sympathetic nerve anywhere other than in the pleura. CONCLUSIONS The lesion would have been produced in the endothoracic fascia, where the cervical sympathetic chain is closely related to the apical pleura, and the physiopathological mechanism would be fibrosis of the aforementioned structures. Many reports have been published that describe the onset of HS as an acute complication following thoracic surgery, but its late development is infrequent.
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Abstract
PURPOSE To highlight that internal carotid artery dissection is a common cause of Horner's syndrome and that it is important to diagnose dissection as anticoagulation can prevent carotid thrombosis and embolism. METHODS Five case reports are presented of patients with Horner's syndrome secondary to carotid dissection. One patient had carotid dissection secondary to trauma, two had spontaneous dissections and two had dissections in the settings of other illness. A literature search was performed on carotid dissection as a cause of Horner's syndrome and its diagnosis and management. RESULTS The case reports and literature highlight that dissection is under-recognized as a cause of Horner's syndrome and can be missed. The investigation of choice is a magnetic resonance imaging and angiography scan of the head and neck. The treatment advocated is anticoagulation for 3-6 months. CONCLUSION Carotid dissection should be suspected in patients with Horner's syndrome, particularly if head or neck pain is present.
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Affiliation(s)
- C C Chan
- Department of Neuro-Ophthalmology, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
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Abstract
A working collie cross was presented with a three-month history of vague neurological signs and a right-sided Horner's syndrome. Denervation hypersensitivity testing suggested a first order syndrome. There was a significant positive titre to Neospora and clinical signs resolved completely following treatment.
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Affiliation(s)
- P Boydell
- Animal Medical Centre Referral Services, Chorlton, Manchester
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van Hagen MA, Kwakernaak CM, Boevé MH, Stades FC. [Horner's syndrome in the dog: a retrospective study]. Tijdschr Diergeneeskd 1999; 124:600-2. [PMID: 10549090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A retrospective study was made of 43 dogs with Horner's syndrome (HS). In the group studied the golden retriever was found to be predisposed for Horner's syndrome. No predisposition in gender or age seemed to exist. Symptomatic treatment with topical 10% phenylephrine alleviates the clinical signs. Generally patients recover in 2 to 6 months.
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Affiliation(s)
- M A van Hagen
- Hoofdafdeling Geneeskunde van Gezelschapsdieren, Faculteit der Diergeneeskunde, Utrecht.
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Abstract
PURPOSE The authors report the clinical findings of a unique case of rapid corneal endothelial decompensation in association with acute Horner syndrome. STUDY DESIGN Case report and literature review. METHODS The authors followed a 38-year-old woman who developed Horner syndrome after right jugular vein catheterization during cardiac valvular surgery. Shortly after the operation, Horner syndrome accompanied by conjunctival hyperemia and stromal corneal edema developed in the right eye. Over the course of 4 months, the eye became painful, the corneal endothelial cell count dropped precipitously, and the stromal edema worsened, causing a difference of 100 microm in central corneal thickness compared to the unaffected eye. Deep stromal vascularization started at the limbus, resembling interstitial keratitis. RESULTS A 3-week course of topical steroid treatment resulted in a dramatic improvement in the stromal corneal edema and regression of the deep stromal vascularization. Ocular and right hemicranial pain subsided shortly thereafter. CONCLUSION The authors hypothesize that corneal endothelial failure in this unique case may have resulted from traumatic sympathectomy. According to experimental evidence in the reviewed ophthalmologic literature, sympathetic innervation may have a neurotrophic role in the cornea. Corneal pathology similar to the authors' case has been described in hemifacial atrophy (Parry-Robson syndrome), a disorder that is assumed to result from sympathetic denervation and that can be produced in animals by cervical sympathectomy. The authors therefore hypothesize that sympathetic denervation of the cornea may rarely cause endothelial decompensation and corneal edema. To the authors' knowledge, this is the first reported case of corneal endothelial failure in Horner syndrome.
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Affiliation(s)
- E Zamir
- Hadassah University Hospital, Jerusalem, Israel.
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Abstract
A 44-year-old man presented with painful Horner syndrome: severe periorbital pain, ptosis, and miosis of his right eye, with intact facial sweating. Lymphadenitis at the right side of his neck preceded the symptoms. MRI and magnetic resonance angiography showed thickening of the right internal carotid artery, extending from the bifurcation to the cavernous sinus, without evidence for dissection. The patient was treated with corticosteroids with immediate improvement. Control MRI scanning was normal after 6 weeks. We conclude that the painful Horner syndrome was caused by a reactive arteritis of the right internal carotid artery.
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Affiliation(s)
- A E Bollen
- Department of Neurology, University of Groningen, The Netherlands
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Parsa CF, George ND, Hoyt CS, George ND. Pharmacological reversal of ptosis in a patient with acquired Horner's syndrome and heterochromia. Br J Ophthalmol 1998; 82:1095. [PMID: 9893610 PMCID: PMC1722743 DOI: 10.1136/bjo.82.9.1090g] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pareja JA, Espejo J, Trigo M, Sjaastad O. Congenital (?) Horners syndrome and ipsilateral headache. Funct Neurol 1997; 12:123-31. [PMID: 9218966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A 31-year-old woman had left-sided miosis, ptosis, and hypopigmented iris probably since birth. At 22, she developed intermittent headaches, always in the left frontotemporal region. These headaches lasted from 1 to 2 days and recurred every 1-2 months. Pain attacks were pressing-pulsatile in character, moderate in intensity, and frequently accompanied by nausea, vomiting, and moderate phono- and photophobia. Various treatment alternatives, such as conventional analgesics and ergotamine failed to improve the attacks. Pizotifen was partially effective. The results of pupillometry and evaporimetry studies were consistent with a 3rd neuron sympathetic hypofunction on the symptomatic side. Autonomic studies and clinical features were consistent with a congenital Horner's syndrome. Conceivably, a sympathetic hypofunction may play a role in the pathogenesis of such headache or in its lateralization. Indomethacin and sumatriptan both seemed to provide absolute pain relief. Some clinical features, the fact that the IHS criteria for migraine are fulfilled and that sumatriptan is efficient, demonstrate the similarity to migraine. The coexistence of strict unilaterality of pain and the probable, complete response to indomethacin indicate a similarity to hemicrania continua in its remitting form. Further information on the effect of sumatriptan in hemicrania continua will help clarify the position of this case vs. hemicrania continua. At this stage, it is probably not possible to classify this case properly.
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Affiliation(s)
- J A Pareja
- Department of Neurology, Regionsykehuset i Trondheim, Trondheim University Hospitals, Norway
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Abstract
PURPOSE To describe the atypical localization and unusual clinical manifestation of an internal carotid artery dissection. METHODS We examined a 43-year-old woman who had sudden onset of left ptosis and miosis with vague dysesthesia around her eye. RESULTS Her examination showed an intrapetrous carotid artery dissection. CONCLUSIONS The intrapetrous segment is an extremely rare localization for an internal carotid artery dissection. The differential diagnosis of acute Horner syndrome should include carotid dissection, which is usually accompanied by other neurologic manifestations.
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Affiliation(s)
- R Bilbao
- Ophthalmology Department, Hospital Ramón y Cajal, Madrid, Spain
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Abstract
An unilateral ptosis in an African spotted eagle own was ameliorated by topical treatment with phenylephrine, strongly suggesting a diagnosis of Horner's syndrome, the first recorded case of this syndrome in a bird.
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Affiliation(s)
- D L Williams
- Department of Veterinary Basic Sciences, Royal Veterinary College, London
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Foster RE, Kosmorsky GS, Sweeney PJ, Masaryk TJ. Horner's syndrome secondary to spontaneous carotid dissection with normal angiographic findings. Arch Ophthalmol 1991; 109:1499-500. [PMID: 1755725 DOI: 10.1001/archopht.1991.01080110033022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Kuritzky S, Fish S. Hydroxyamphetamine mydriasis in normal subjects and hydroxyamphetamine mydriasis in Horner's syndrome. Am J Ophthalmol 1990; 110:716-7. [PMID: 2248348 DOI: 10.1016/s0002-9394(14)77081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Glauser TA, Brennan PJ, Galetta SL. Reversible Horner's syndrome and Lyme disease. J Clin Neuroophthalmol 1989; 9:225-8. [PMID: 2531158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Neurologic manifestations of Lyme disease are common, often debilitating, and potentially treatable. We document a case of Borrelia infection of the nervous system manifesting as a reversible Horner's syndrome. The search for Lyme disease should be part of the evaluation of an isolated central or preganglionic Horner's syndrome or any unexplained pupillary abnormality.
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Affiliation(s)
- T A Glauser
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia
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Campbell WW, Hill TA. A good treatment for Horner's syndrome. N Engl J Med 1978; 299:835. [PMID: 692574 DOI: 10.1056/nejm197810122991518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Winnie AP, Ramamurthy S, Durrani Z, Radonjic R, Shaker MH. Pharmacologic reversal of Horner's syndrome following stellate ganglion block. Anesthesiology 1974; 41:615-7. [PMID: 4433064 DOI: 10.1097/00000542-197412000-00017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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