Outline the diagnostic features of Horner’s Syndrome and list the likely causes in patients in Intensive Care.
College Answer
Horner’s Syndrome is due to damage to the cervical sympathetic pathway, and exhibits a smaller pupil [miosis: due to reduced pupilo-dilation], a variable degree of ptosis and anhydrosis [impaired sweating over variable area] ± bloodshot eye [loss of vasoconstrictor]. The presence of enophthalmos is controversial. Likely causes include common lesions along the path of the sympathetic pathway: including from brainstem (CVA) and cervical cord lesions (including trauma and local anaesthetic eg. epidural), through T1 root lesions (malignant disease eg. Pancoast syndrome; traction injuries to arm or aneurysms of aortic arch or subclavian artery), along the chain in the neck (malignancy, neck surgery, carotid artery dissection). Transient Horner’s can occur with cluster headaches and with migraine. Many cases have no demonstrable cause.
Discussion
Features of Horner's Syndrome:
- Ptosis
- Miosis
- Anhidrosis of the forehead
- Enophthalmos
Causes of Horner's |
Associated clinical findings: |
Cluster headache |
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Cortical stroke (hemispheric) |
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Brainstem stroke (lateral medullary syndrome) |
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Cavernous sinus pathology |
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Syringobulbia |
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Syringomyelia |
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Spinal injury or infarction |
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Malignancy in the apex of the lung |
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Thyroid cancer |
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Neck trauma or surgery |
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Lower trunk brachial plexus injuries |
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Carotid aneurysm or dissection |
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