Evaluation of pediatric patients presenting with acute-onset unilateral transient acquired blepharoptosis / Avaliação de pacientes pediátricos apresentando blefaroptose transitória unilateral de início agudo

ABSTRACT Purpose: To evaluate the clinical features of pediatric patients with acute-onset, unilateral transient acquired blepharoptosis. Methods: In this retrospective study, the clinical records of patients between April 2015 and June 2020 were reviewed for evaluation of demographic features, accompanying neurological and ophthalmologic manifestations, symptom duration, etiological cause, and imaging findings. Patients with congenital and acquired blepharoptosis with chronic etiologies were excluded. Results: Sixteen pediatric patients (10 boys and 6 girls) with acquired acute-onset unilateral transient blepharoptosis were included in this study. The patients' mean age was 6.93 ± 3.16 years. The most commonly identified etiological cause was trauma in 7 patients (43.75%) and infection (para-infection) in 5 patients (31.25%). In addition, Miller Fisher syndrome, Horner syndrome secondary to neuroblastoma, acquired Brown's syndrome, and pseudotumor cerebri were identified as etiological causes in one patient each. Additional ocular findings accompanied blepharoptosis in 7 patients (58.33%). Blepharoptosis spontaneously resolved, without treatment, in all the patients, except those with Miller Fisher syndrome, neuroblastoma, and pseudotumor cerebri. None of the patients required surgical treatment and had ocular morbidities such as amblyopia. Conclusion: This study demonstrated that acute-onset unilateral transient blepharoptosis, which is rare in childhood, may regress without the need for surgical treatment in the pediatric population. However, serious pathologies that require treatment may present with blepharoptosis.

RESUMO Objetivo: Avaliar as características clínicas de pacientes pediátricos com blefaroptose adquirida unilateral, transitória e de início agudo. Métodos: Neste estudo retrospectivo, foram revisados prontuários clínicos entre abril de 2015 e junho de 2020. Os pacientes foram avaliados em termos de características demográficas, manifestações neurológicas e oftalmológicas associadas, duração dos sintomas, etiologia e achados de imagem. Foram excluídos pacientes com blefaroptose congênita e com blefaroptose adquirida de etiologia crônica. Resultados: Foram incluídos neste estudo 16 pacientes pediátricos (10 masculinos e 6 femininos) com blefaroptose adquirida transitória unilateral de início agudo. A média de idade dos pacientes foi de 6,93 ± 3,16 anos. As causas etiológicas mais comumente identificadas foram trauma em 7 pacientes (43,75%) e infecção (casos parainfecciosos) em 5 pacientes (31,25%). Além disso, a síndrome de Miller-Fisher, a síndrome de Horner secundária a neuroblastoma, a síndrome de Brown adquirida e pseudotumor cerebral foram determinados como causas etiológicas em um paciente cada uma. Achados oculares adicionais estavam associados à blefaroptose em 7 pacientes (58,33%). Foi observada a resolução espontânea da blefaroptose, sem tratamento, em todos os pacientes, exceto nos pacientes com síndrome de Miller-Fisher, neuroblastoma e pseudotumor cerebral. Nenhum paciente precisou de tratamento cirúrgico. Morbidades oculares, como ambliopia, não foram encontradas em nenhum paciente. Conclusão: Este estudo demonstrou que a blefaroptose transitória unilateral de início agudo, rara na infância, pode regredir sem a necessidade de tratamento cirúrgico na população pediátrica. No entanto, também não deve ser esquecido que patologias graves que requerem tratamento podem se apresentar com blefaroptose.

Cirugía de la ptosis palpebral: análisis de tres tipos de procedimientos quirúrgicos. Serie de Casos / Eyelid ptosis surgery: analysis of three types of surgical procedures. Number of cases

INTRODUCCIÓN. La ptosis palpebral se define como el descenso o disfunción del párpado con respecto a su posición considerada como normal, pudiendo causar alteraciones del campo visual. Puede dividirse en lesiones congénitas o adquiridas, por el grado de disfunción entre otros. Blefaroplastia, es el término para la corrección de la misma. Existen varias técnicas correctivas quirúrgicas y no quirúrgicas. CASOS. Se presenta una serie de 5 casos tratados mediante abordaje quirúrgico anterior; detallando la técnica quirúrgica utilizada, con corrección de las estructuras hipertrofiadas, sección, suspensión, sutura del elevador palpebral o su encortamiento; suspensión de índole estática con el uso de fascia del paciente y finalizando el procedimiento con la confección del surco palpebral superior. RESULTADOS. Los 5 pacientes fueron tratados con técnicas quirúrgicas individualizadas obteniéndose buenos resultados estéticos y funcionales, sin complicaciones durante o después del procedimiento. DISCUSIÓN. La técnica de blefaroplastia quirúrgica dependerá del grado de disfunción; se describen tres principales: Fasanella Servat, para ptosis leve y útil para ptosis congénita leve o síndrome de Horner; Reinserción de la aponeurosis del músculo elevador, técnica que respeta la anatomía y permite regular diferentes grados de ptosis; y Suspensión del párpado al músculo frontal pudiendo ser definitiva o reversible. La edad de intervención para ptosis congénita antes del año de edad es urgente, si tapa la pupila para así evitar ambliopía y tortícolis compensatoria, en el resto de casos se sugiere realizarla a partir de los 5 años de edad. CONCLUSIONES. El conocimiento adecuado de la anatomía palpebral, etiología de la dermatocalasia y blefaroptosis, permite realizar una correcta cirugía reparadora individualizada para cada paciente. Las técnicas presentadas en este trabajo son reproducibles.

INTRODUCTION. Palpebral ptosis is defined as the descent or dysfunction of the eyelid with respect to its position considered as normal, which can cause alterations in the visual field. It can be divided into congenital or acquired lesions, according to the degree of dysfunction, among others. Blepharoplasty is the term for its correction. There are several surgical and non-surgical corrective techniques. CASES. We present a series of 5 cases treated by anterior surgical approach; detailing the surgical technique used, with correction of the hypertrophied structures, section, suspension, suture of the palpebral elevator or its shortening; static suspension with the use of the patient's fascia and ending the procedure with the confection of the superior palpebral sulcus. RESULTS. All 5 patients were treated with individualized surgical techniques obtaining good aesthetic and functional results, without complications during or after the procedure. DISCUSSION. The surgical blepharoplasty technique will depend on the degree of dysfunction; three main techniques are described: Fasanella Servat, for mild ptosis and useful for mild congenital ptosis or Horner syndrome; Reinsertion of the levator muscle aponeurosis, a technique that respects the anatomy and allows regulating different degrees of ptosis; and Eyelid suspension to the frontalis muscle, which can be definitive or reversible. The age of intervention for congenital ptosis before one year of age is urgent, if it covers the pupil in order to avoid amblyopia and compensatory torticollis, in the rest of cases it is suggested to perform it from 5 years of age. CONCLUSIONS. The adequate knowledge of the palpebral anatomy, etiology of dermatochalasis and blepharoptosis, allows a correct individualized reparative surgery for each patient. The techniques presented in this work are reproducible.

Aspectos anatômicos, fisiopatológicos e clínicos da Síndrome de Horner: um guia ilustrado / Anatomical, pathophysiological and clinical aspects of Horner Syndrome: illustrated guide

A Síndrome de Horner (SH) é classicamente caracterizada por uma tríade clínica: miose/anisocoria, ptose e anidrose facial. Sua fisiopatologia está relacionada à interrupção da via oculossímpatica, no entanto os mecanismos que levam a instalação da síndrome são diversos, e alguns até potencialmente fatais, evidenciando a importância de sua identificação precoce. Elucidamos ao longo deste artigo os principais aspectos anatômicos, etiopatogênicos e clínicos desta condição neurológica

Horner Syndrome (HS) is classically characterized by a triad of symptoms: miosis/anisocoria, ptosis and facial anhidrosis. It's pathophysiology is related to the interruption of the oculosympathetic pathway, but the mechanisms that lead to the onset of the syndrome are diverse, and some are even potentially lethal, highlighting the importance of it's early diagnosis. This article elucidates main anatomical, etiopathogenic and clinical aspects of this neurological disorder.

Neuroblastoma cervical: presentación de casos y revisión actualizada del tema / Cervical neuroblastoma: presentation of cases and updated review of the topic

El neuroblastoma es uno de los tumores sólidos extracraneales más comunes en la edad pediátrica, y se origina en células precursoras del sistema nervioso simpático. La ubicación cervical corresponde a un 2-5% del total de los neuroblastomas y puede tener distintas manifestaciones clínicas, tales como masa cervical, disnea, estridor, síndrome de Horner o disfagia. Esta entidad debe ser considerada dentro del diagnóstico diferencial de una masa cervical pediátrica, especialmente ante la presencia de masas sólidas, laterales o paramedianas, palpables o no al examen físico. El tratamiento específico del neuroblastoma depende de la clasificación de riesgo del paciente, pudiendo ser expectante en casos específicos, exclusivamente quirúrgico, o bien requerir complementarse con otras terapias. En este artículo se presentan 2 casos clínicos de pacientes pediátricos con neuroblastoma cervical tratados de forma exclusiva y exitosa con cirugía, y una revisión del tema.

Neuroblastoma is one of the commonest extracranial solid tumors at pediatric age, originating from sympathetic nervous system precursor cells. Cervical position stands for 2-5% of all neuroblastomas, with variable clinical expression that includes cervical mass, dyspnea, stridor, Horner syndrome and dysphagia. This condition must be considered in the differential diagnosis of a pediatric cervical mass, specially in those solid, lateral/paramedian masses that could be palpable or not at physical examination. The specific treatment in neuroblastoma depends on patient´s risk group, including conservative follow-up in selected cases, surgery alone, or complementary perioperative therapy with chemotherapy and others. In this article, the group report two cases of cervical neuroblastoma exclusively treated with surgery with good results, and a literature review.

Delayed Onset Abducens Nerve Palsy and Horner Syndrome after Treatment of a Traumatic Carotid-cavernous Fistula

PURPOSE: We report a patient with delayed-onset abducens nerve palsy and Horner syndrome after endovascular treatment of traumatic carotid-cavernous fistula (CCF). CASE SUMMARY: A 68-year-female visited our ophthalmic department complaining of gradual-onset ptosis of the left eye and horizontal diplopia. She had undergone endovascular treatment to treat left-sided traumatic CCF after a car accident 10 years before; she had been told at that time that the treatment outcome was favorable. The left-sided ptosis gradually developed 6 years after the procedure, accompanied by diplopia. The left eye exhibited miosis and the extent of anisocoria increased in dim light. An extraocular examination revealed 30 prism diopters of left esotropia in the primary gaze and a −4 abduction limitation of the left eye. CCF recurrence was suspected; however, magnetic resonance imaging with magnetic resonance angiography of brain did not support this. The esotropia did not improve during the 6-month follow-up and strabismus surgery was performed. CONCLUSIONS: Delayed-onset abducens nerve palsy and Horner syndrome can develop even after successful endovascular treatment of CCF. Strabismus surgery should be considered in patients whose diplopia does not spontaneously improve.

Síndrome de Horner como presentación de tuberculosis pulmonar / Horner's syndrome as presentation of pulmonary tuberculosis

El síndrome de Horner es el resultado de un bloqueo de la inervación simpática del ojo en cualquier punto de su trayectoria. Puede tener variadas etiologías, y es una forma muy inusual de presentación de tuberculosis pulmonar. Se describe el caso de un paciente que presenta un síndrome de Horner secundario a afectación del ápex pulmonar por tuberculosis.

Horner´s syndrome results from a blockage of the sympathetic innervation to the eye at any point along its trajectory. It presents various etiologies, and it is a very unusual form of presentation of pulmonary tuberculosis. We describe the case of a patient with a Horner syndrome secondary to involvement of the pulmonary apex due to tuberculosis.

Transient Horner's syndrome after single shot paravertebral block / Síndrome de Horner transitória após bloqueio paravertebral em injeção única

Abstract Background Thoracic paravertebral block can provide analgesia for unilateral chest surgery and is associated with a low complication rate. Horner syndrome also referred to as oculosympathetic paresis, is a classic neurologic constellation of ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis resulting from disruption of the sympathetic pathway supplying the head, eye, and neck. Case report We present a patient with an ipsilateral transient Horner syndrome after ultrasound guided single shot of 15 mL 0.25% levobupivacaine for thoracic paravertebral block at T5-6 level. Conclusions It should be kept in mind that even a successful ultrasound guided single shot thoracic paravertebral block can be complicated with Horner syndrome due to unpredictable distribution of the local anesthetic.

Resumo Justificativa O bloqueio paravertebral torácico pode proporcionar analgesia para cirurgia torácica unilateral e está associado a um baixo índice de complicações. A síndrome de Horner (também denominada paralisia oculossimpática) é uma constelação neurológica clássica de blefaroptose ipsilateral, miose pupilar e anidrose facial devido a distúrbio da via simpática que fornece inervação para a cabeça, os olhos e o pescoço. Relato de caso Apresentamos o caso de um paciente com síndrome de Horner transitória ipsilateral após a administração de injeção única de 15 mL de levobupivacaína a 0,25% para bloqueio paravertebral torácico ao nível de T5-6 guiado por ultrassom. Conclusões Devemos considerar que mesmo um bloqueio paravertebral torácico bem-sucedido com a administração de injeção única e guiado por ultrassom pode ser complicado com a síndrome de Horner devido à distribuição imprevisível do anestésico local.

Horner's syndrome and paresthesia in the trigeminal nerve territory secondary to epidural analgesia for labor / Síndrome de Horner e parestesia do território do nervo trigêmeo secundário a analgesia peridural para trabalho de parto

Abstract Currently, epidural analgesia is a common procedure for labor analgesia. Although it is considered a safe technique, it is not without complications. Horner's syndrome and paresthesia within the trigeminal nerve distribution are rare complications of epidural analgesia. We report a case of a pregnant woman who developed Horner's syndrome and paresthesia within the distribution of the trigeminal nerve following epidural analgesia for the relief of labor pain.

Resumo A analgesia peridural é hoje em dia um procedimento comum para analgesia do trabalho de parto. Embora seja considerada uma técnica segura, não está isenta de complicações. A síndrome de Horner e a parestesia do território do nervo trigêmeo são complicações raras da analgesia peridural. Relatamos um caso de uma grávida que desenvolveu a síndrome de Horner e parestesia do território do nervo trigêmeo após analgesia peridural para o alívio da dor do trabalho de parto.

Smdrome de Horner congénito: Caso clmico / Congenital Horner syndrome: Case report

El síndrome de Horner está caracterizado por la siguiente tríada de signos clínicos: miosis, ptosis y anhidrosis facial. A su vez, pueden aparecer heterocromía del iris, inyección conjuntival, eritema facial, mucosa nasal congestiva y enoftalmos aparente secundario a la disminución de la hendidura palpebral. Es causado por una interrupción de la vía simpática, que se extiende desde el hipotálamo hasta la órbita. Debido a que dicha vía no se decusa, los signos son homolaterales a la lesión de esta. Tradicionalmente, se lo clasifica en congénito y adquirido. En ocasiones, se asocia a neoplasias, como el neuroblastoma. Sigue siendo controversial qué estudios de imágenes se deberían solicitar en forma protocolizada frente a un paciente con este síndrome neurológico. Se presenta el caso de un lactante de 45 días de vida con síndrome de Horner congénito.

Horner syndrome is characterized by the following triad of clinical signs: miosis, ptosis and facial anhidrosis. In addition, iris heterochromia, conjunctival injection, facial erythema, congestive nasal mucosa and apparent enophthalmos secondary to the reduction of the palpebral fissure can appear. It is caused by an interruption of the sympathetic pathway that extends from the hypothalamus to the orbit. Because there is no decussation, the signs are homolateral to the lesion. Traditionally, it is classified as congenital and acquired. Occasionally, it is associated with neoplasias such as neuroblastoma. It remains controversial what imaging studies should be requested as a protocolized workup of this neurological syndrome in a patient. We report the case of a 45-day-old infant with congenital Horner syndrome.

Síndrome de Horner secundária a neoplasia de esôfago: relato de caso / Horner's syndrome secondary to esophageal cancer: a case report

A síndrome de Horner resulta de uma lesão das fibras simpáticas destinadas ao olho e classicamente se apresenta com ptose palpebral parcial, miose e anidrose de uma hemiface ipsilateral ao local acometido. As causas mais comuns relacionadas a ela são o traumatismo cirúrgico de estruturas cervicais, dissecção da carótida interna e processos neoplásicos, principalmente tumor de Pancoast, raramente relacionase com neoplasia esofagiana. Neste relato de caso descrito, a paciente apresenta síndrome de Horner secundária a um tumor de esôfago. A atenção ao exame físico e a propedêutica adequada fazem total diferença na detecção desta síndrome necessitando de exames complementares para elucidar a sua etiologia. O tratamento pode ser eficaz quando se detecta precocemente a causa. (AU)

Horner's syndrome results from a lesion of sympathetic fibers to eye and classically presents with partial ptosis, miosis and anhidrosis of the ipsilateral hemifacial the affected site. The most common causes related to it are the surgical trauma of cervical structures, dissection of the internal carotid and neoplastic processes, especially tumor Pancoast, rarely related to esophageal cancer. In this report the case described, the patient has Horner syndrome secondary to esophageal tumor. Attention to physical examination and appropriate workup make all the difference in the detection of this syndrome requiring additional tests to elucidate its etiology. The treatment may be effective if early detect the cause. (AU)

Síndrome de Brown Sequard em associação à síndrome de Horner / Brown Sequard Syndrome In Association With Horner Syndrome

O trauma raquimedular (TRM) é uma importante causa de incapacidade, sendo constatado uma incidência média de 21 pacientes por milhão de habitantes por ano por uma revisão sistemática realizada nas cinco regiões do pais em. Em Belo Horizonte essa incidência chegou a 26 pacientes por milhão por ano. Trata-se de AFC, 28 anos, que foi encaminhado com urgência para o Hospital João XXIII com história de agressão por arma branca (um facão) na região supra clavicular esquerda no dia 22/10. Ao exame neurológico o paciente encontrava-se consciente, orientado e com hemiplegia á esquerda. Anestesia tátil e vibratória á esquerda (lesão do trato corticoespinhal e fascículo grácil e cuneiforme) e preservada á direita, além de anestesia térmica/dolorosa contralateral a hemissecção (lesão do trato espinotalâmico), que configuram a síndrome de Brown Sequard completa. Foi realizada tomografia computadorizada da coluna que evidenciou fratura de lâmina de T1. A ferida lacerante foi suturada e paciente manteve quadro estável por 5 dias. Após 7 dias da admissão hospitalar constatou-se anisocoria com pupila miótica à esquerda e ptose de pálpebra também a esquerda, que configura a síndrome de Horner concomitantemente. Foi realizada punção lombar constatando liquor hemorrágico e com alta celularidade, iniciado antibioticoterapia com Meropenem e Vancomicina. Relata-se a correlação anátomoclínica de paciente vitima de TRM aberto, com síndromes associadas, de hemissecção medular e Horner. Ressalta-se a importância dos conhecimentos em neuroanatomia. (AU)

Spinal cord trauma is an important cause of disability, with an average incidence of 21 patients per million inhabitants per year by a systematic review in the five regions of Brazil. In Belo Horizonte, this incidence reached 26 patients per million per year. This is the AFC, 28 years old, who was referred urgently to the Hospital João XXIII with a history of white-collar aggression (a machete) in the left supraclavicular region on 22/10. At the neurological examination the patient was conscious, oriented and with left hemiplegia. Tactile and vibratory anesthesia to the left (lesion of the corticospinal tract and gracile and cuneiform fasciculus) and preserved to the right, in addition to thermal / painful anesthesia contralateral to the hemisection (lesion of the spinothalamic tract), which constitute the complete Brown Sequard syndrome. Computed tomography of the spine was performed, showing a T1 fracture. The lacerating wound was sutured and patient maintained stable frame for 5 days. After 7 days of hospital admission, anisocoria was observed with miotic pupil on the left and ptosis of the eyelid also on the left, which configures Horner syndrome concomitantly. A lumbar puncture was performed, confirming hemorrhagic and high cellularity, and antibiotic therapy with Meropenem and Vancomycin. The anatomic-clinical correlation of a patient with open MTR with associated syndromes of medullary and Horner hemisection is reported. The importance of knowledge in neuroanatomy is emphasized. (AU)

Tumor maligno da bainha perineural retrobulbar e intracraniano em cão: relato de caso / Malignant neoplasm of the perineural sheath retrobulbar and intracranial in dog: case report

Os tumores da bainha perineural são pouco frequentes em animais domésticos. Relata-se o caso de um cão, sem raça definida, de cinco anos, fêmea, com histórico de aumento de volume em região retrobulbar do globo ocular direito (GOD) havia três semanas. Ao exame clínico, constatou-se a presença de uma neoformação retrobulbar direita com deslocamento do globo ocular cranialmente. Aos exames realizados durante o internamento, não foi possível localizar a origem e a extensão da neoformação. O animal veio a óbito por parada cardiorrespiratória e foi encaminhado para a necropsia. À avaliação macroscópica, observou-se neoformação esbranquiçada fixada à base do crânio em região selar, com possível origem no terceiro (III) par de nervos cranianos, a qual se infiltrava no encéfalo na altura do hipotálamo, estendia-se caudalmente em direção ao tronco encefálico e cranialmente à órbita direita, comprimindo, assim, o GOD. Microscopicamente consistia de feixes curtos entrelaçados ou enovelados de células fusiformes com pleomorfismo discreto a moderado, alternando-se a áreas de necrose multifocalmente, compatível com tumor da bainha perineural. Ao exame imuno-histoquímico, apresentou marcação fraca para S100 e GFAP e marcação positiva para vimentina, o que indica caráter maligno.(AU)

Tumors of the perineural sheath are uncommon in domestic animals. We report the case of a 5-year-old female dog with a history of increased volume in the retrobulbar region of the right eye (RE) three weeks ago. The clinical examination revealed a presence of a right retrobulbar neoformation with cranial ocular globe displacement. In the examinations carried out during hospitalization, it was not possible to locate a source and an extension of the neoformation. The animal died of cardiorespiratory arrest and was referred to an autopsy. The macroscopic evaluation revealed a whitish neoformation fixated to the base of the skull in a seal region, with a possible non-III origin of cranial nerves, infiltrating non-encephalon at the height of the hypothalamus, extending caudally towards the brainstem and cranially to the orbit right, compressing RE. Microscopically it consisted of short bundles intertwined or enovelados of spindle cells with discrete to moderate pleomorphism, alternating to areas of multifocal necrosis, compatible with tumor of the perineural sheath. Immunohistochemical examination showed weak marking for S100 and GFAP and positive marking for vimentin, indicating malignancy.(AU)

Unilateral Horner's Syndrome following supraclavicular brachial plexus block / 고신대학교의과대학학술지

Supraclavicular brachial plexus block, due to its wide range of indications, is the most widely practiced procedure in anesthesiology. We experienced the case of a 45-year-old female patient who developed unilateral Horner's Syndrome after the use of supraclavicular brachial plexus block. The patient recovered spontaneously from the Horner's syndrome after 2 hours. If Horner's syndrome should occur, its etiology will need to be assessed. It is also important to assure the patient they will recover from the complication within a year.

Changes in blood flow at the mandibular angle and Horner syndrome in a rat model of superior cervical ganglion block

BACKGROUND: A stellate ganglion block (SGB) causes increased blood flow in the maxillofacial region, exhibiting the potential for regenerative effects in damaged tissue. The focus of this study was to understand the efficacy of SGB for regenerative effects against nerve damage. A rat model of the superior cervical ganglion block (SCGB) was created instead of SGB, and facial blood flow, as well as sympathetic nervous system function, were measured. METHODS: A vertical incision was made on the left side of the neck of a Wistar rat, and a 5-mm resection of the superior cervical ganglion was performed at the back of the bifurcation of the internal and external branches of the left common carotid artery. Blood flow in the skin at the mandibular angle and mean facial temperature were measured using a laser-Doppler blood flow meter and a thermographic camera, respectively, over a 5-week period after the block. In addition, the degree of ptosis and miosis were assessed over a period of 6 months. RESULTS: The SCGB rat showed significantly higher blood flow at the mandibular angle on the block side (P < 0.05) for 3 weeks, and significantly higher skin temperature (P < 0.05) for 1 week after the block. In the SCGB rat, ptosis and miosis occurred immediately after the block, and persisted even 6 months later. CONCLUSIONS: SCGB in rats can cause an increase in the blood flow that persists over 3 weeks.

Síndrome de Brown-Séquard em associação à síndrome de Horner / Brown Sequard Syndrome In Association With Horner Syndrome

O trauma raquimedular (TRM) é uma importante causa de incapacidade, sendo constatado uma incidência média de 21 pacientes por milhão de habitantes por ano por uma revisão sistemática realizada nas cinco regiões do pais em. Em Belo Horizonte essa incidência chegou a 26 pacientes por milhão por ano. Trata-se de AFC, 28 anos, que foi encaminhado com urgência para o Hospital João XXIII com história de agressão por arma branca (um facão) na região supra clavicular esquerda no dia 22/10. Ao exame neurológico o paciente encontrava-se consciente, orientado e com hemiplegia á esquerda. Anestesia tátil e vibratória á esquerda (lesão do trato corticoespinhal e fascículo grácil e cuneiforme) e preservada á direita, além de anestesia térmica/dolorosa contralateral a hemissecção (lesão do trato espinotalâmico), que configuram a síndrome de Brown Sequard completa. Foi realizada tomografia computadorizada da coluna que evidenciou fratura de lâmina de T1. A ferida lacerante foi suturada e paciente manteve quadro estável por 5 dias. Após 7 dias da admissão hospitalar constatou-se anisocoria com pupila miótica à esquerda eptose de pálpebra também a esquerda, que configura a síndrome de Horner concomitantemente. Foi realizada punção lombar constatando liquor hemorrágico e com alta celularidade, iniciado antibioticoterapia com Meropenem e Vancomicina. Relata-se a correlação anátomoclínica de paciente vitima de TRM aberto, com síndromes associadas, de hemissecção medular e Horner. Ressalta-se a importância dos conhecimentos em neuroanatomia. (AU)

Spinal cord trauma is an important cause of disability, with an average incidence of 21 patients per million inhabitants per year by a systematic review in the five regions of Brazil. In Belo Horizonte, this incidence reached 26 patients per million per year. This is the AFC, 28 years old, who was referred urgently to the Hospital João XXIII with a history of white-collar aggression (a machete) in the left supraclavicular region on 22/10. At the neurological examination the patient was conscious, oriented and with left hemiplegia. Tactile and vibratory anesthesia to the left (lesion of the corticospinal tract and gracile and cuneiform fasciculus) and preserved to the right, in addition to thermal / painful anesthesia contralateral to the hemisection (lesion of the spinothalamic tract), which constitute the complete Brown Sequard syndrome. Computed tomography of the spine was performed, showing a T1 fracture. The lacerating wound was sutured and patient maintained stable frame for 5 days. After 7 days of hospital admission, anisocoria was observed with miotic pupil on the left and ptosis of the eyelid also on the left, which configures Horner syndrome concomitantly. A lumbar puncture was performed, confirming hemorrhagic and high cellularity, and antibiotic therapy with Meropenem and Vancomycin. The anatomic-clinical correlation of a patient with open MTR with associated syndromes of medullary and Horner hemisection is reported. The importance of knowledge in neuroanatomy is emphasized. (AU)

Approach to pupillary abnormalities via anatomical pathways / 영남의대학술지

The pupillary size and movement are controlled dynamically by the autonomic nervous system; the parasympathetic system constricts the iris, while the sympathetic system dilates the iris. Under normal conditions, these constrictions and dilations occur identically in both eyes. Asymmetry in the pupillomotor neural input or output leads to impaired pupillary movement on one side and an unequal pupil size between both eyes. Anisocoria is one of the most common signs in neuro-ophthalmology, and the neurological disorders that frequently cause anisocoria include serious diseases, such as vascular dissection, fistula, and aneurysm. A careful history and examination can identify and localize pupillary disorders and provide a guide for appropriate evaluations.

Unusual Horner's Syndrome in Recurrent Breast Cancer: Evaluation Using ¹⁸F-FDG PET/CT / 대한핵의학회잡지

¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a widely used imaging modality in the initial diagnosis of cancer, treatment response evaluation and detection of recurrence. Herein, we present the case of a 39-year-old female who presented right ptosis on the follow-up of breast cancer after surgery. Clinicians suspected Horner's syndrome, and the patient underwent FDG PET/CT for the evaluation of recurrence that could cause Horner's syndrome. FDG PET/CT demonstrated a focal hypermetabolic lesion in the right cervicothoracic junction area, corresponding to the preganglionic cervical sympathetic trunk. A subsequent needle biopsy was done, and the lesion was confirmed as metastatic ductal carcinoma. In this case, we could detect the exact location of the recurring lesion that caused Horner's syndrome using FDG PET/CT.

Approach to pupillary abnormalities via anatomical pathways / 영남의대학술지

The pupillary size and movement are controlled dynamically by the autonomic nervous system; the parasympathetic system constricts the iris, while the sympathetic system dilates the iris. Under normal conditions, these constrictions and dilations occur identically in both eyes. Asymmetry in the pupillomotor neural input or output leads to impaired pupillary movement on one side and an unequal pupil size between both eyes. Anisocoria is one of the most common signs in neuro-ophthalmology, and the neurological disorders that frequently cause anisocoria include serious diseases, such as vascular dissection, fistula, and aneurysm. A careful history and examination can identify and localize pupillary disorders and provide a guide for appropriate evaluations.

Síndrome de Horner tras analgesia epidural para el parto. Informe de 3 casos / Horner syndrome after epidural analgesia for labor. Report on three cases

Epidural analgesia is assumed to be the technique of choice for the relief of pain in labor. Multiple adverse neurological effects have been reported, one of which is the so-called Horner syndrome (ptosis, myosis, anhidrosis). Its evolution is usually benign and does not require specific management, except clinical monitoring for the more than probable cephalic spread of local anesthetic. Most of the cases that exist in the literature are isolated; in our work we present a series of 3 clinical cases and review the pathogenesis and management in the obstetric patient.

La analgesia epidural supone la técnica de elección para el alivio del dolor del parto. Se han descrito múltiples efectos adversos a nivel neurológico, uno de ellos es el llamado Síndrome de Horner (ptosis,miosis, anhidrosis), suele presentar evolución benigna y no requiere manejo especifico, salvo vigilancia clínica por la más que probable difusión cefálica del anestésico local. La mayor parte de los casos existentes en la literatura son aislados, en nuestro trabajo presentamos una serie de 3 casos clínico y repasamos su etiopatogenía y manejo en la paciente obstétrica.

A neonate with Joubert syndrome presenting with symptoms of Horner syndrome / 소아과

Joubert syndrome (JS) is characterized by the “molar tooth sign” (MTS) with cerebellar vermis agenesis, episodic hyperpnea, abnormal eye movements, and hypotonia. Ocular and oculomotor abnormalities have been observed; however, Horner syndrome (HS) has not been documented in children with JS. We present the case of a 2-month-old boy having ocular abnormalities with bilateral nystagmus, left-dominant bilateral ptosis, and unilateral miosis and enophthalmos of the left eye, which were compatible with HS. Brain magnetic resonance imaging (MRI) revealed the presence of the MTS. Neck MRI showed no definite lesion or mass around the cervical sympathetic chain. His global development was delayed. He underwent ophthalmologic surgery, and showed some improvement in his ptosis. To the best of our knowledge, the association of HS with JS has not yet been described. We suggest that early neuroimaging should be considered for neonates or young infants with diverse eye abnormalities to evaluate the underlying etiology.