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{{SK}} Bernard-Horner syndrome; oculosympathetic palsy
{{SK}} Bernard-Horner syndrome; oculosympathetic palsy; Horner syndrome


==Overview==
== [[Horner's syndrome overview|Overview]] ==
Horner's syndrome is a clinical [[syndrome]] caused by damage to the [[sympathetic nervous system]].
==[[Horner's syndrome historical perspective|Historical Perspective]]==
== [[Horner's syndrome pathophysiology|Pathophysiology]] ==
== [[Horner's syndrome causes|Causes]] ==


==Signs==
== [[Horner's syndrome differential diagnosis|Differentiating Horner's syndrome from other Diseases]] ==
Signs found in all patients on affected side of face include [[ptosis (eyelid)|ptosis]] (drooping upper eyelid from loss of sympathetic innervation to the [[Heinrich Müller (physiologist)|Müller]]-[[Charles Marie Benjamin Rouget|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]]).<ref>{{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  | id=PMID 16319395}}</ref> This happens because a lack of sympathetic stimulation in childhood interferes with [[melanin]] pigmentation of the [[melanocyte]]s in the superficial stroma of the [[Iris (anatomy)|iris]].
== [[Horner's syndrome epidemiology and demographics|Epidemiology and Demographics]] ==
== [[Horner's syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]] ==


==History==
==Diagnosis==
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".
 
==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]]<ref>{{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}}</ref>
* [[Physical trauma|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 block]]s, such as cervical plexus block, stellate ganglion or interscalene block
* [[Brainstem]] [[stroke]]
* [[Carotid body]] tumor
* [[Lymphoma]]
* [[Mediastinal]] mass
* [[Metastasis]]
* [[Parotid gland|Parotid gland tumor]]
* [[Tuberculosis|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==
[[Horner's syndrome history and symptoms|History and Symptoms]] | [[Horner's syndrome physical examination|Physical Examination]] | [[Horner's syndrome laboratory findings|Laboratory Findings]] |  [[Horner's syndrome chest x ray|Chest X Ray]] | [[Horner's syndrome CT|CT]] | [[Horner's syndrome MRI|MRI]] | [[Horner's syndrome ultrasound|Ultrasound]] | [[Horner's syndrome other imaging findings|Other Imaging Findings]] | [[Horner's syndrome other diagnostic studies|Other Diagnostic Studies]]
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 [[mydriasis|dilation]] of a normal pupil. The pupil will fail to dilate in Horner's syndrome.
#[[p-Hydroxyamphetamine|Paredrine]] test
#Dilation lag test


It is important to distinguish the [[ptosis (eyelid)|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.
==Treatment==
[[Horner's syndrome medical therapy|Medical Therapy]] | [[Horner's syndrome surgery|Surgery]] | [[Horner's syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Horner's syndrome future or investigational therapies|Future or Investigational Therapies]]


<div align="left">
==Case Studies==
<gallery heights="175" widths="175">
[[Horner's syndrome case study one|Case #1]]
Image:Eyes horners.jpg|Horner's Syndrome
Image:Eyes horners2.jpg|Horner's Syndrome
</gallery>
</div>


==Related Chapters==
==Related Chapters==
* [[Miosis]]
* [[Anisocoria]]
* [[Anisocoria]]
 
* [[Ptosis]]
==References==
* [[Anhidrosis]]
{{Reflist|2}}


{{PNS diseases of the nervous system}}
{{PNS diseases of the nervous system}}


[[Category:Emergency medicine]]
[[Category:Emergency medicine]]

Latest revision as of 19:06, 19 February 2013

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

Synonyms and keywords: Bernard-Horner syndrome; oculosympathetic palsy; Horner syndrome

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Horner's syndrome from other Diseases

Epidemiology and Demographics

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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Case #1

Related Chapters

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