Horner’s Syndrome Disease – The Healing Space Clinic

Horner's Syndrome Disease

BASICS

DESCRIPTION

Horner's syndrome is caused by interruptions of the sympathetic nerve supply to the eye and results in miosis, ptosis, and absence of sweating of the ipsilateral face and neck

Peripheral lesion - distal to superior cervical ganglion
Central lesion - proximal to superior cervical ganglion
System(s) affected: Nervous, Skin/Exocrine
Genetics: Some autosomal dominant familial incidence
Incidence/Prevalence in USA: Unknown
Predominant age: May occur at any age
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Ptosis (drooping of the eyelid)
Miosis (narrowing of the pupil of the eye)
Anhidrosis
Enophthalmos is sometimes found
Iris (in congenital Horner's) reduced - pigmentation, blue-gray, mottled of the affected eye
Loss of ciliospinal reflex

CAUSES

Interruption of the sympathetic nerve fibers that originate in the hypothalamus and travel down to the lateral part of the brain stem to exit in the thoracic area. These fibers synapse in the cervical sympathetic ganglia and the postganglionic fibers travel to the eye along the wall of the carotid and ophthalmic arteries.
Idiopathic

RISK FACTORS

Apical bronchogenic carcinoma
Aneurysm of the carotid or subclavian artery
Injuries to the carotid artery high in the neck
Congenital Horner's syndrome
Dissection of the carotid arteries
Cluster headaches, approximately 20% of which have an accompanying ipsilateral Horner's syndrome. The syndrome may outlast the headaches.
Carotid artery occlusion, approximately 15% of patients with carotid artery occlusion develop ipsilateral Horner's syndrome - may occur without evidence of cerebral ischemia, neck injuries or operative procedures
Syringomyelia
Inflammatory process

DIAGNOSIS

LABORATORY

N/A

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Brainstem lesion
Massive hemisphere lesion
Cervical cord lesion
Root lesion
Sympathetic chain lesion

SPECIAL TESTS

Instillation of 4% solution of cocaine into conjunctival sac produces dilatation of the pupil in Horner's syndrome caused by a central sympathetic pathways lesion. (Response is absent in peripheral sympathetic lesion.)
Instillation of 1:1000 solution of epinephrine into conjunctival sac produces dilatation of the pupil in Horner's syndrome caused by a peripheral sympathetic lesion

IMAGING

CT/MRI of the brain, chest, spinal cord

DIAGNOSTIC PROCEDURES

Spinal tap - occasionally indicated in addition to above.

TREATMENT

APPROPRIATE HEALTH CARE

Inpatient or outpatient, depending upon cause

GENERAL MEASURES

Search for tumor or other compressive lesion is indicated for any patient who develops Horner's syndrome
Horner's syndrome in itself does not produce any disability or require treatment
Treatment is management of the underlying condition

SURGICAL MEASURES

N/A

ACTIVITY

Disease dependent

DIET

Disease dependent

PATIENT EDUCATION

N/A

FOLLOW UP

PREVENTION/AVOIDANCE

None known

POSSIBLE COMPLICATIONS

Chronic pupillary constriction

EXPECTED COURSE AND PROGNOSIS

Variable with cause

MISCELLANEOUS

ASSOCIATED CONDITIONS

Wallenberg's syndrome
Pancoast's tumor
C8 radiculopathy

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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