- Horner's syndrome.

Horner's syndrome

*Def:-

It is a clinical syndrome caused by damage to the sympathetic nerve supply to head and neck.

*synonymes:-

• Bernard-Horner syndrome
• oculosympathetic palsy.

*Causes:-

Due to lesion or compression of one side of the cervical or thoracic sympathetic chain which generates symptoms on the ipsilateral (same side as lesion) side of the body:-

• Lateral medullary syndrome.
• Trauma - base of neck, usually blunt trauma, sometimes surgery.
• Middle ear infection.
• Tumors - often bronchogenic carcinoma of the superior fissure (Pancoast tumor) on apex of lung.
• Aortic aneurysm.
• Neurofibromatosis type 1.
• Goitre.
• Dissecting aortic aneurysm.
• Thyroid carcinoma.
• Multiple sclerosis.
• Cervical rib traction on stellate ganglion.
• Carotid artery dissection.
• Klumpke paralysis.
• Cavernous sinus thrombosis.
• Sympathectomy.
• Syringomyelia.
• Nerve blocks, such as cervical plexus block, stellate ganglion or interscalene block.
• As a complication of tube thoracostomy.

*Signs:-

1-Ptosis:-which is drooping of the upper eyelid from loss of sympathetic innervation to the superior tarsal muscle.
2-Miosis (constricted pupil due to paralysis of dilator puplliae muscle).
3-Anhydrosis (decreased sweating leading to dryness of the affected side of the face).
4-Enophthalmos (sinking of eye ball into the orbit due to paralysis of muller's muscle).
5-Vasodilation of skin blood vessels due to loss of sympathetic vasoconstrictive tone to blood vessels so there is flushing of the face on the affected side of the face.

*In children Horner syndrome sometimes leads to a difference in eye color between the two eyes (heterochromia).This happens because a lack of sympathetic stimulation in childhood interferes with melanin pigmentation of the melanocytes in the superficial stroma of the iris.

N.B:-To confirm the diagnosis, doctors may apply eye drops that contain small amounts of cocaine to the affected eye. If the pupil does not widen (dilate) after 30 minutes, Horner's syndrome is diagnosed.

*Investigations:-

Investigations will be guided by suspected aetiology.

*TREATMENT:-

Treatment depends on the location and cause of the lesion.

Dr Ibrahim

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