causes of horner's syndrome

Causes of Horner Syndrome: A Study of 318 Patients 2. When there are such clinically localizing clues, they should be conveyed to the interpreting radiologist because some lesions may have subtle imaging signs, as was the case in our single patient with longus colli contusion. These differences in the prevalence of various causes of Horner syndrome might be explained by whether or not Horner syndrome is pharmacologically confirmed. For pharmacologic confirmation, we relied on topical apraclonidine, a now more commonly used pharmacologic indicator of Horner syndrome than cocaine, epinephrine, or hydroxyamphetamine, which were used in prior studies. Surgical sympathectomy for reflex sympathetic dystrophy syndromes. Some error has occurred while processing your request. WebHorner syndrome classically consists of ptosis, miosis, and sometimes anhidrosis. As the name suggests, winged scapula is a rare condition in which the shoulder blade juts out in a wing-like way from the back causing upper extremity limitations in lifting, pulling, and pushing. Although congenital Horner syndrome can be passed down in families, no associated genes have been identified. Raising the arm (deltoid), flexing the elbow (bicep), and rotating the arm outwards (using the external rotator muscles of the rotator cuff) may be restricted as a result of motor weakness. Notably, a study of 52 inpatients and outpatients with topical cocaine-confirmed Horner syndrome drawn from the case records of a single neuro-ophthalmologist (5) found that only 16% were of indeterminate origin. In these 318 cases, we documented patient demographics, ophthalmologic features, imaging, underlying cause, and whether the cause was discovered before or after the diagnosis of Horner syndrome. There were 21 patients, or 13% of the entire cohort, who had anisocoria without ptosis (idiopathic7, postprocedure4, cluster headache2, congenital2, brachial plexus contusion1, carotid canal basal skull fracture1, metastatic lung squamous cell carcinoma to carotid1, and uncertain3). De Lott, and J. D. Trobe. Recognizing Horners syndrome. Bictegravir, Emtricitabine, and Tenofovir, Diphtheria, Tetanus, and Pertussis (DTaP) Vaccine. HHS Vulnerability Disclosure, Help The https:// ensures that you are connecting to the Apraclonidine for the pharmacologic confirmation of acute Horner syndrome. eCollection 2022. Stroke was the cause in only 7 patients (thalamic stroke4, dorsolateral medullary infarct2, and superior cerebellar artery infarct1). However, in an important minority of cases, mostly involving carotid dissection or tumor, the identification of Horner syndrome was critical to the discovery of those conditions. Keep reading to learn more about Horners syndrome, including the symptoms, causes, related conditions, and treatment options. Beers MH, Berkow R., eds. 8) Horner syndrome will usually display a combination of ptosis and miosis, but miosis may occur without ptosis, with the understanding that small amounts of ptosis can be easily overlooked. Pupil size was recorded in millimeters in the dimmest possible illumination that permitted pupil size measurement; anisocoria was expressed as the difference in pupil size between the 2 eyes under this condition. Ophthalmic Plast Reconstr Surg. That diagnosis does not appear in the older reports probably because it only became feasible in the era of modern noninvasive vascular imaging. Rarely, congenital Horner syndrome is passed down within a family in a pattern that appears to be autosomal dominant, which means one copy of an altered gene in each cell is sufficient to cause the disorder. Disclaimer. Within the autonomic nervous system, the nerves are part of a subdivision called the sympathetic nervous system. The Yield of Diagnostic Imaging in Patients with Isolated Horner Syndrome. Horners syndrome is often the result of an interruption to this group of nerves through physical injury. Digre KB, Smoker WR, Johnston P, Tryhus MR, Thompson HS, Cox TA, Yuh WT. Our study included 9 patients with neck trauma and negative carotid artery imaging in whom we presume the mechanism was contusion of the Horner fibers adjacent to the carotid wall. Evaluation of Horner Syndrome in the MRI Era, Privacy Policy (Updated December 15, 2022), North American Neuro-Ophthalmology Society. ORL J Otorhinolaryngol Relat Spec. Causes Of Horner Syndrome 2002;64:49-52. Arch Neurol. Asia Pac J Ophthalmol. Horner Syndrome: Overview, Anatomy, Pathophysiology - Medscape This can be the result of compression of the vascular structures (arteries and/or veins), neurological structures (nerves between the shoulder and neck, known as the brachial plexus), or involvement of both the vascular and neurological structures. If an adequate diagnostic evaluation failed to determine a probable cause of Horner syndrome, we labeled the cases idiopathic. If an adequate evaluation had not been performed, or we lacked sufficient information to assign a reasonable cause for Horner syndrome, we considered the cause to be uncertain. Cases that were idiopathic or uncertain were considered to be of indeterminate cause. We conducted a retrospective study of patients with Horner syndrome evaluated at the University of Michigan from 1996 to 2018. Acquired Horners syndrome: clinical review. 3) If the cause is not known at the time of Horner syndrome diagnosis, carotid dissection may be the cause even if acute neck or face pain is not described. Some people with Horner syndrome have neither a known problem that would lead to nerve damage nor any history of the disorder in their family. In the pharmacologically-unconfirmed cases, there were only 6 cases in which a cause was not known to the examiner making the Horner diagnosis. 19. 2015;50:107111. Osteoarthritis of the neck or neck trauma can also result in Horner's syndrome. The signs and symptoms of Horner syndrome can also occur during a migraine headache. Horner's syndrome is an interruption of the sympathetic supply to the eye, resulting in the classic triad of ptosis, miosis, and anhydrosis. Among apraclonidine-confirmed cases, 159 met inclusion criteria. 6th ed. Patients with injuries to the brachial plexus or other major nerve injuries near the neck or shoulder may have complete or partial loss of function in the arm, with or without sensation. 2010;30:7072. Many of those cases involved neck and chest procedures that had occurred during an inpatient stay. This form of brachial plexus injury involves disruption of nerves at the C8 and T1 levels. 1) When the diagnosis of Horner syndrome is based on pharmacologic confirmation, it is often an isolated abnormality and a definite cause will often not be found even in the face of adequate investigation. 5. Carotid dissection was the second most common identifiable cause of Horner syndrome in our study. Anisocoria The inability of the infant to bend his or her elbow is a hallmark of a birth palsy. The syndrome appears after the newborn period (acquired Horner syndrome) and most cases of congenital Horner syndrome result from damage to nerves called the cervical sympathetics. Fetzer SJ. Only 3 patients described lack of sweating on the ipsilateral face (excision of paraspinal neuroblastoma1, neck surgery1, and idiopathic1). The term birth palsy (or paralysis) refers to injuries to the brachial plexus incurred as the baby emerges from the birth canal. Once this connection is disrupted, the joint becomes unstable and the scapula pops out of place. De Lott, and J. D. Trobe. Horner syndrome is a rare disorder that affects males and females in equal numbers and may occur at any age, among any ethnic grouping in any geographic location. Cases were accrued through a search that detected all text mentions of Horner syndrome with and without pharmacologic confirmation, allowing for a broader inclusion than studies dependent on personal files or discharge diagnoses. In the pharmacologically-confirmed cohort, there were 80 men and 79 women, ranging in age from 4 to 87 years (median 51, interquartile range [IQR] 3462). In the pharmacologically-confirmed cases, the diagnosis of Horner syndrome was made on outpatients in 79% of cases, an expected result because testing with apraclonidine is more practical in the outpatient setting. Among pharmacologically-unconfirmed cases, a substantial proportion had also been caused by neck and chest procedures, but tumors in that region were also common. Conception and design: M. A. Sabbagh, L. B. Journal of Neuro-Ophthalmology40(3):362-369, September 2020. Among pharmacologically-unconfirmed cases, a substantial proportion had also been caused by neck and chest procedures, but tumors in that region were also common. It may also cause changes in skin color, a sunken appearance of the eye, and redness of the eye. A condition in which scar tissue has grown around a disrupted nerve. Distribution of 159 Patients with Pharmacologically-Confirmed Horner Syndrome, Distribution of 159 Patients with Pharmacologically-Unconfirmed Horner Syndrome, MeSH K23 EY027849/EY/NEI NIH HHS/United States. We used strict definitions of causation. In both groups, when a cause for Horner syndrome could be identified, that cause was nearly always known before Horner syndrome was identified. 2002;35:269-77. side, Unequal pupil color in congenital or early acquired cases, Exposure to topical medications or plants that due to scarring of the iris may be the first abnormality noted. Neurol Clin. severe inflammation. A 1980 study of 450 patients examined in an outpatient ophthalmology clinic (4) also found tumor to be the most common identifiable cause. In the pharmacologically-unconfirmed cases, it was not possible to determine reliably whether the diagnosis was first made in the outpatient or inpatient setting. Analysis of 100 hospitalized patients. 2000. A drooping eye is often a sign of an avulsion, a complete tear of the nerve from its attachment at the spinal cord. 2023 Feb;33(1):63-67. doi: 10.1007/s10286-022-00914-w. Epub 2022 Dec 12. Category 3: a. There is an extremely long list of causes. In the pharmacologically-confirmed Horner cohort, 97 (62%) had Horner syndrome on the right side and 59 (38%) on the left side. 2017;35:145151. Bandyk DF, Johnson BL, Kirkpatrick AF, et al. There is no conflict of interest to disclose. The underlying causes can vary enormously, from a snake or insect bite to a neck trauma made by a blunt instrument. Oxford, UK; 1999:612-13. Horners Syndrome This Various dates. It is characterized by a drooping eyelid (ptosis), decreased pupil size (myosis), and dryness of the eye (anhidrosis). Lippincott Williams & Wilkins. In our 2 cohorts, there were 29 cases in which the diagnosis of Horner syndrome triggered the investigation leading to a cause for Horner syndrome, of which 12 had no localizing clues. The site is secure. 1982;39:108111. The general cause of Horners syndrome is damage to the nerve pathway between the brain and the face in what is called the sympathetic nervous system. Conclusions: Giles CL, Henderson JW. 2 and Table 1). Center for Brachial Plexus and Traumatic Nerve Injury, About Brachial Plexus and Traumatic Nerve Injury, Brachial Plexus Doctors, Surgeons and Specialists, Seeing a Physician at the Center for Brachial Plexus and Traumatic Nerve Injury, Symptoms of Brachial Plexus and Serious Nerve Injury. Trobe JD. Parsonage-Turner Syndrome (PTS), also referred to as idiopathic brachial plexopathy or neuralgic amyotrophy, is a rare disorder consisting of a complex constellation of symptoms with abrupt onset of pain in the shoulder, which is followed by progressive neurologic increasing of motor weakness, a reduced sense of touch, and numbness. 2021 Jan 13;21(1):36. doi: 10.1186/s12893-020-01042-w. Kuchalska K, Barekowska M, Derwich K, Joczyk-Potoczna K, Gotz-Wickowska A. Childs Nerv Syst. When surgical intervention is necessary, good outcomes can be achieved in appropriately screened patients. 2000;15:124-28. 2002. Infants may have either partial birth palsy, in which only the upper or the lower roots are damaged, or complete birth palsy or avulsion of all the nerve roots. with iritis secondary to juvenile idiopathic Anisocoria associated with other 3. Headache. 11. Clin Auton Res. 17. Background: There was no association between age or sex and discovering a cause for Horner syndrome. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government website. J Pediatr Ophthalmol Strabismus. Horner's syndrome: an analysis of 216 cases.
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