Updated: 7/25/2019

Horner Syndrome

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Topic
https://upload.medbullets.com/topic/113037/images/autonomics of the eye - moises dominguez.jpg
Snapshot
  • A 67-year-old man presents to his physician following a right-sided carotid endarterectomy. He reports mild pain at the surgical site but currently does not have any concerns. On physical exam, there is anisocoria with the right eye being miotic. There is also mild ptosis on the right eye as well.
Introduction
  • Clinical definition
    • a neurologic syndrome characterized by ipsilateral
      • miosis
      • ptosis
      • anhidrosis
  • Pathogenesis 
    • can be caused by a lesion anywhere on the sympathetic pathway supplying the 
      • head, eyes, and neck
        • review the sympathetic course in this illustration
    • causes include
      • Pancoast tumor 
      • Wallenberg syndrome
      • syringomyelia and cervical cord trauma that affects the
        • intermediolateral columns
      • carotid endarterectomy and carotid artery stenting
      • carotid dissection
Presentation
  • Symptoms and physical exam
    • miosis
      • resulting in anisocoria
      • secondary to unchecked parasympathetic innervation
    • ptosis
      • due to impaired sympathetic innervation to Muller's muscle
      • generally mild
    • anhidrosis
      • suggests an central or preganglionic lesion

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(M1.NE.17.4766) A 65-year-old woman presents to her physician's office for a follow-up appointment for recently diagnosed bronchitis. The patient reports that her cough has not resolved and feels fatigued. Medical history is significant for hypertension and hyperlipidemia, which is currently being treated with hydrochlorothiazide and atorvastatin. She also has a 30 pack-year smoking history. Her temperature is 99°F (37.2°C), blood pressure is 140/90 mmHg, pulse is 105/min, respirations are 22/min, and oxygen saturation is 93% on room air. On physical exam, the patient's eyes are shown in Figure A. Cardiac and abdominal exam is unremarkable. This patient’s symptoms are most likely due to a pathological development that affects which of the following?

QID: 109044
FIGURES:
1

Middle cervical ganglion

22%

(34/154)

2

Superior vena cava

10%

(15/154)

3

Stellate ganglion

33%

(51/154)

4

Recurrent laryngeal nerve

4%

(6/154)

5

Oculomotor nerve

25%

(38/154)

M 1 C

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Evidence (3)
EXPERT COMMENTS (6)
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