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| {{SK}} Bernard-Horner syndrome; oculosympathetic palsy | | {{SK}} Bernard-Horner syndrome; oculosympathetic palsy; Horner syndrome |
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| ==Overview== | | == [[Horner's syndrome overview|Overview]] == |
| Horner's syndrome is a clinical [[syndrome]] caused by damage to the [[sympathetic nervous system]]. | | ==[[Horner's syndrome historical perspective|Historical Perspective]]== |
| | == [[Horner's syndrome pathophysiology|Pathophysiology]] == |
| | == [[Horner's syndrome causes|Causes]] == |
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| ==Signs== | | == [[Horner's syndrome differential diagnosis|Differentiating Horner's syndrome from other Diseases]] == |
| Signs found in all patients on affected side of face include [[ptosis (eyelid)|ptosis]] (drooping upper eyelid from loss of sympathetic innervation to the [[Heinrich Müller (physiologist)|Müller]]-[[Charles Marie Benjamin Rouget|Rouget]] muscle), upside-down ptosis (slight elevation of the lower lid), and [[miosis]] (constricted pupil) and dilation lag. [[Enophthalmos]] (the impression that the eye is sunk in) and [[anhidrosis]] (decreased [[sweating]]) on the affected side of the face, loss of [[ciliospinal reflex]] and blood shot conjunctiva may occur depending on the site of lesion.
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| In children Horner's syndrome sometimes leads to a difference in eye color between the two eyes ([[heterochromia]]).<ref>{{cite journal | author=Gesundheit B, Greenberg M | title=Medical mystery: brown eye and blue eye--the answer | journal=N Engl J Med | year=2005 | pages=2409-10 | volume=353 | issue=22 | id=PMID 16319395}}</ref> This happens because a lack of sympathetic stimulation in childhood interferes with [[melanin]] pigmentation of the [[melanocyte]]s in the superficial stroma of the [[Iris (anatomy)|iris]].
| | == [[Horner's syndrome epidemiology and demographics|Epidemiology and Demographics]] == |
| | == [[Horner's syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
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| ==History== | | ==Diagnosis== |
| It is [[eponym|named after]] [[Johann Friedrich Horner]], the Swiss [[ophthalmology|ophthalmologist]] who first described the syndrome in 1869.<ref>Horner JF. ''Über eine Form von Ptosis.'' Klin Monatsbl Augenheilk 1869;7:193-8.</ref><ref>{{WhoNamedIt|synd|1056}}</ref> 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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| ==Differential diagnosis of causes of Horner's syndrome==
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| 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.
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| * Due to lesion of one side of the cervical sympathetic chain which affects on the same side of the lesion
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| * [[PICA syndrome]]
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| * [[Cluster headache]] - combination termed [[Horton's headache]]<ref>{{cite web | author=Graff JM, Lee AG | title=Horner's Syndrome (due to Cluster Headache): 46 y.o. man presenting with headache and ptosis. | url=http://webeye.ophth.uiowa.edu/eyeforum/cases/case22.htm | work=Ophthalmology Grand Rounds | date=February 21, 2005 | publisher=The University of Iowa | accessdate=2006-09-22}}</ref>
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| * [[Physical trauma|Trauma]] - base of neck, usually blunt trauma.
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| * [[Middle ear infection]]
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| * [[Tumors]] - often [[bronchogenic carcinoma]] of the superior fissure ([[Pancoast tumor]])
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| * [[Thoracic aortic aneurysm]]
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| * [[Neurofibromatosis type 1]]
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| * [[Goitre]]
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| * [[Dissecting aortic aneurysm]]
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| * [[Thyroid carcinoma]]
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| * [[Multiple sclerosis]]
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| * [[Carotid artery dissection]]
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| * [[Klumpke paralysis]]
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| * [[Cavernous sinus thrombosis]]
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| * [[Sympathectomy]]
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| * [[Syringomyelia]]
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| * [[Nerve block]]s, such as cervical plexus block, stellate ganglion or interscalene block
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| * [[Brainstem]] [[stroke]]
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| * [[Carotid body]] tumor
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| * [[Lymphoma]]
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| * [[Mediastinal]] mass
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| * [[Metastasis]]
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| * [[Parotid gland|Parotid gland tumor]]
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| * [[Tuberculosis|Tuberculosis adenitis]]
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| == Pathophysiology ==
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| Horner's syndrome is due to a deficiency of [[sympathetic]] activity.
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| The site of lesion to the sympathetic outflow is on the [[ipsilateral]] side of the symptoms.
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| The following are examples of conditions that cause the clinical appearance of Horner's syndrome:
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| *''First-order neuron disorder:'' Central lesions that involve the hypothalamospinal pathway (e.g. transection of the cervical spinal cord).
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| *''Second-order neuron disorder:'' [[Preganglionic]] lesions (e.g. compression of the sympathetic chain by a lung tumor).
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| *''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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| ==Diagnosis==
| | [[Horner's syndrome history and symptoms|History and Symptoms]] | [[Horner's syndrome physical examination|Physical Examination]] | [[Horner's syndrome laboratory findings|Laboratory Findings]] | [[Horner's syndrome chest x ray|Chest X Ray]] | [[Horner's syndrome CT|CT]] | [[Horner's syndrome MRI|MRI]] | [[Horner's syndrome ultrasound|Ultrasound]] | [[Horner's syndrome other imaging findings|Other Imaging Findings]] | [[Horner's syndrome other diagnostic studies|Other Diagnostic Studies]] |
| Three tests are useful in confirming the presence and severity of Horner's syndrome:
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| #Cocaine drop test - [[Cocaine]] blocks the reuptake of [[norepinephrine]] resulting in the [[mydriasis|dilation]] of a normal pupil. The pupil will fail to dilate in Horner's syndrome.
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| #[[p-Hydroxyamphetamine|Paredrine]] test
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| #Dilation lag test
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| It is important to distinguish the [[ptosis (eyelid)|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 CNIII ([[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.
| | ==Treatment== |
| | [[Horner's syndrome medical therapy|Medical Therapy]] | [[Horner's syndrome surgery|Surgery]] | [[Horner's syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Horner's syndrome future or investigational therapies|Future or Investigational Therapies]] |
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| <div align="left">
| | ==Case Studies== |
| <gallery heights="175" widths="175">
| | [[Horner's syndrome case study one|Case #1]] |
| Image:Eyes horners.jpg|Horner's Syndrome
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| Image:Eyes horners2.jpg|Horner's Syndrome
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| </gallery>
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| </div>
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| ==Related Chapters== | | ==Related Chapters== |
| | * [[Miosis]] |
| * [[Anisocoria]] | | * [[Anisocoria]] |
| | | * [[Ptosis]] |
| ==References==
| | * [[Anhidrosis]] |
| {{Reflist|2}}
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| {{PNS diseases of the nervous system}} | | {{PNS diseases of the nervous system}} |
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| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
