- Horner's syndrome
Name = PAGENAME
Caption = Left-sided Horner's syndrome
DiseasesDB = 6014
ICD10 = ICD10|G|90|2|g|90
ICD9 = ICD9|337.9
OMIM = 143000
MedlinePlus = 000708
eMedicineSubj = med
eMedicineTopic = 1029
eMedicine_mult = eMedicine2|oph|336 | MeshID = D006732
Horner's syndrome is a clinical
syndromecaused by damage to the sympathetic nervous system. It is also known by the names Bernard-Horner syndrome or oculosympathetic palsy.
Signs found in all patients on affected side of face include ptosis (drooping upper eyelid from loss of sympathetic innervation to the Müller or
superior tarsal musclecite book |author=Adams, Raymond Delacy; Victor, Maurice; Ropper, Allan H. |title=Adam and Victor's principles of neurology |publisher=McGraw-Hill |location=New York |year=2001 |pages= |isbn=0-07-067497-3 |oclc= |doi=] ), 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 reflexand blood shot conjunctiva may occur depending on the site of lesion. Also flushing of the face is common on the affected side of the face due to dilation of blood vessels under the skin.
In children Horner's syndrome sometimes leads to a difference in eye color between the two eyes (
heterochromia). [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 | pmid=16319395 | doi=10.1056/NEJM200512013532219] This happens because a lack of sympathetic stimulation in childhood interferes with melaninpigmentation of the melanocytes in the superficial stroma of the iris.
It is named after
Johann Friedrich Horner, the Swiss ophthalmologist who first described the syndrome in 1869. [Horner JF. "Über eine Form von Ptosis." Klin Monatsbl Augenheilk 1869;7:193-8.] [WhoNamedIt|synd|1056] Several others had previously described cases, but "Horner's syndrome" is most prevalent. In Franceand Italy, Claude Bernardis also eponymised with the condition ("Claude Bernard-Horner syndrome").
Horner's syndrome is acquired as a result of pathology 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(tumor in the apex of the lung) or thyrocervical venous dilatation).
* Due to lesion or compression of one side of the cervical or thoracic sympathetic chain which generates symptoms on the
ipsilateral(same side as lesion) side of the body.
Lateral medullary syndrome
Cluster headache- combination termed Horton's headache [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]
* Trauma - base of neck, usually blunt trauma, sometimes surgery.
Middle ear infection
Tumors- often bronchogenic carcinomaof the superior fissure ( Pancoast tumor) on apex of lung
Aortic aneurysm, thoracic
Neurofibromatosis type 1
Dissecting aortic aneurysm
Carotid artery dissection
Cavernous sinus thrombosis
Nerve blocks, such as cervical plexus block, stellate ganglion or interscalene block
Horner's syndrome is due to a deficiency of
sympatheticactivity.The site of lesion to the sympathetic outflow is on the ipsilateralside 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:"
Preganglioniclesions (e.g. compression of the sympathetic chain by a lung tumor).
*"Third-order neuron disorder:"
Postganglioniclesions at the level of the internal carotid artery (e.g. a tumor in the cavernous sinus).
Three tests are useful in confirming the presence and severity of Horner's syndrome:
#Cocaine drop test -
Cocaineblocks the reuptake of norepinephrineresulting in the dilation of a normal pupil. Due to the lack of norepinephrine in the synaptic cleft, the pupil will fail to dilate in Horner's syndrome.
#Paredrine test:- This test helps to localize the cause of the miosis. If the 3rd order neuron (the last of 3 neurons in the pathway which ultimately discharges norepinephrine into the synaptic cleft) is intact, then the amphetamine causes neurotransmitter vesicle release, thus releasing norepinephrine into the synaptic cleft and resulting in robust mydriasis of the affected pupil. If the lesion itself is of the aforementioned 3rd order neuron, then the amphetamine will have no effect and the pupil remains constricted. There is no pharmacological test to differentiate between a 1st and 2nd order neuron lesion.
#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.
anisocoriaoccurs and the examiner is unsure whether the abnormal pupil is the constricted or dilated one, if a one-sided ptosis is present then the abnormally sized pupil can be presumed to be the one on the side of the ptosis.
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Look at other dictionaries:
Horner's syndrome — Hor·ner s syndrome hȯr nərz n a syndrome marked by sinking in of the eyeball, contraction of the pupil, drooping of the upper eyelid, and vasodilation and anhidrosis of the face, and caused by paralysis of the cervical sympathetic nerve fibers… … Medical dictionary
Horner ptosis syndrome — Hor·ner ptosis, syndrome (horґnər) [Johann Friedrich Horner, Swiss ophthalmologist, 1831â€“1886] see under ptosis and syndrome … Medical dictionary
Horner's syndrome — a syndrome consisting of a constricted pupil, drooping of the upper eyelid (ptosis), and an absence of sweating over the affected side of the face. The symptoms are due to a disorder of the sympathetic nerves in the brainstem or cervical (neck)… … The new mediacal dictionary
Horner's syndrome — noun a pattern of symptoms occurring as a result of damage to nerves in the cervical region of the spine (drooping eyelids and constricted pupils and absence of facial sweating) • Hypernyms: ↑syndrome … Useful english dictionary
Syndrome de Claude-Bernard-Horner — Pour les articles homonymes, voir CBH. Le syndrome de Claude Bernard Horner (CBH ou SCBH) est caractérisé par la concomitance de quatre signes cliniques : ptosis, myosis, énophtalmie ainsi qu une vasodilation et une absence de sudation… … Wikipédia en Français
Syndrome de Horner — Syndrome de Claude Bernard Horner Pour les articles homonymes, voir CBH. Le syndrome de Claude Bernard Horner (CBH ou SCBH) est caractérisé par la concomitance de quatre signes cliniques : ptosis, myosis, énophtalmie ainsi qu une… … Wikipédia en Français
Syndrome de claude bernard-horner — Pour les articles homonymes, voir CBH. Le syndrome de Claude Bernard Horner (CBH ou SCBH) est caractérisé par la concomitance de quatre signes cliniques : ptosis, myosis, énophtalmie ainsi qu une vasodilation et une absence de sudation… … Wikipédia en Français
Horner — is an English surname that derives from the occupation horner who is a person who cuts the horns off cattle, or deals in horns , or plays a horn.Horner refers to: *People named Horner **Bob Horner (1957 ndash;), American professional baseball… … Wikipedia
Syndrome de Claude Bernard-Horner — Pour les articles homonymes, voir CBH. Syndrome de Claude Bernard Horner Classification et ressources externes … Wikipédia en Français
Horner syndrome — A complex of abnormal findings, namely sinking in of one eyeball, ipsilateral ptosis (drooping of the upper eyelid on the same side) and miosis (constriction of the pupil of that eye) together with anhidrosis (lack of sweating) and flushing of… … Medical dictionary