Horner's syndrome: Difference between revisions

	WikiDoc Resources for Horner's syndrome
Articles
Most recent articles on Horner's syndrome Most cited articles on Horner's syndrome Review articles on Horner's syndrome Articles on Horner's syndrome in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Horner's syndrome Images of Horner's syndrome Photos of Horner's syndrome Podcasts & MP3s on Horner's syndrome Videos on Horner's syndrome
Evidence Based Medicine
Cochrane Collaboration on Horner's syndrome Bandolier on Horner's syndrome TRIP on Horner's syndrome
Clinical Trials
Ongoing Trials on Horner's syndrome at Clinical Trials.gov Trial results on Horner's syndrome Clinical Trials on Horner's syndrome at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Horner's syndrome NICE Guidance on Horner's syndrome NHS PRODIGY Guidance FDA on Horner's syndrome CDC on Horner's syndrome
Books
Books on Horner's syndrome
News
Horner's syndrome in the news Be alerted to news on Horner's syndrome News trends on Horner's syndrome
Commentary
Blogs on Horner's syndrome
Definitions
Definitions of Horner's syndrome
Patient Resources / Community
Patient resources on Horner's syndrome Discussion groups on Horner's syndrome Patient Handouts on Horner's syndrome Directions to Hospitals Treating Horner's syndrome Risk calculators and risk factors for Horner's syndrome
Healthcare Provider Resources
Symptoms of Horner's syndrome Causes & Risk Factors for Horner's syndrome Diagnostic studies for Horner's syndrome Treatment of Horner's syndrome
Continuing Medical Education (CME)
CME Programs on Horner's syndrome
International
Horner's syndrome en Espanol Horner's syndrome en Francais
Business
Horner's syndrome in the Marketplace Patents on Horner's syndrome
Experimental / Informatics
List of terms related to Horner's syndrome

	Horner's syndrome;
ICD-10	G90.2
ICD-9	337.9
OMIM	143000
DiseasesDB	6014
MedlinePlus	000708
eMedicine	med/1029 oph/336
MeSH	D006732

VisualWikitext

Revision as of 17:19, 24 January 2009

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Synonyms and keywords: It is also known by the names Bernard-Horner syndrome or oculosympathetic palsy.

Overview

Horner's syndrome is a clinical syndrome caused by damage to the sympathetic nervous system.

Signs

Signs found in all patients on affected side of face include ptosis (drooping upper eyelid from loss of sympathetic innervation to the Müller-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.

In children Horner's syndrome sometimes leads to a difference in eye color between the two eyes (heterochromia).^[1] This happens because a lack of sympathetic stimulation in childhood interferes with melanin pigmentation of the melanocytes in the superficial stroma of the iris.

History

It is named after Johann Friedrich Horner, the Swiss ophthalmologist who first described the syndrome in 1869.^[2]^[3] 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".

Differential diagnosis of causes of Horner's syndrome

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.

Due to lesion of one side of the cervical sympathetic chain which affects on the same side of the lesion
PICA syndrome
Cluster headache - combination termed Horton's headache^[4]
Trauma - base of neck, usually blunt trauma.
Middle ear infection
Tumors - often bronchogenic carcinoma of the superior fissure (Pancoast tumor)
Thoracic aortic aneurysm
Neurofibromatosis type 1
Goitre
Dissecting aortic aneurysm
Thyroid carcinoma
Multiple sclerosis
Carotid artery dissection
Klumpke paralysis
Cavernous sinus thrombosis
Sympathectomy
Syringomyelia
Nerve blocks, such as cervical plexus block, stellate ganglion or interscalene block
Brainstem stroke
Carotid body tumor
Lymphoma
Mediastinal mass
Metastasis
Parotid gland tumor
Tuberculosis adenitis

Pathophysiology

Horner's syndrome is due to a deficiency of sympathetic activity. The site of lesion to the sympathetic outflow is on the ipsilateral side of the symptoms. The following are examples of conditions that cause the clinical appearance of Horner's syndrome:

First-order neuron disorder: Central lesions that involve the hypothalamospinal pathway (e.g. transection of the cervical spinal cord).
Second-order neuron disorder: Preganglionic lesions (e.g. compression of the sympathetic chain by a lung tumor).
Third-order neuron disorder: Postganglionic lesions at the level of the internal carotid artery (e.g. a tumor in the cavernous sinus).

Diagnosis

Three tests are useful in confirming the presence and severity of Horner's syndrome:

Cocaine drop test - Cocaine blocks the reuptake of norepinephrine resulting in the dilation of a normal pupil. The pupil will fail to dilate in Horner's syndrome.
Paredrine test
Dilation lag test

It is important to distinguish the 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.

Horner's Syndrome
Horner's Syndrome

References

↑ Gesundheit B, Greenberg M (2005). "Medical mystery: brown eye and blue eye--the answer". N Engl J Med. 353 (22): 2409–10. PMID 16319395.
↑ Horner JF. Über eine Form von Ptosis. Klin Monatsbl Augenheilk 1869;7:193-8.
↑ Template:WhoNamedIt
↑ Graff JM, Lee AG (February 21, 2005). "Horner's Syndrome (due to Cluster Headache): 46 y.o. man presenting with headache and ptosis". Ophthalmology Grand Rounds. The University of Iowa. Retrieved 2006-09-22.

Template:PNS diseases of the nervous system Template:SIB

de:Horner-Syndrom sv:Horners syndrom

Template:WH Template:WikiDoc Sources

[1] Gesundheit B, Greenberg M (2005). "Medical mystery: brown eye and blue eye--the answer". N Engl J Med. 353 (22): 2409–10. PMID 16319395.

[2] Horner JF. Über eine Form von Ptosis. Klin Monatsbl Augenheilk 1869;7:193-8.

[3] Template:WhoNamedIt

[4] Graff JM, Lee AG (February 21, 2005). "Horner's Syndrome (due to Cluster Headache): 46 y.o. man presenting with headache and ptosis". Ophthalmology Grand Rounds. The University of Iowa. Retrieved 2006-09-22.

[1]

[2]

[3]

[4]

@@ Line 19: / Line 19: @@
 {{EH}}
-{{SK}}
+{{SK}} It is also known by the names '''Bernard-Horner syndrome''' or '''oculosympathetic palsy'''.
 ==Overview==
-'''Horner's syndrome''' is a clinical [[syndrome]] caused by damage to the [[sympathetic nervous system]]. It is also known by the names '''Bernard-Horner syndrome''' or '''oculosympathetic palsy'''.
+'''Horner's syndrome''' is a clinical [[syndrome]] caused by damage to the [[sympathetic nervous system]].
 ==Signs==
@@ Line 32: / Line 32: @@
 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".
-==Causes==
+==Differential diagnosis of causes of Horner's syndrome==
 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.