Horner syndrome after cervical spine corticosteroid injection.

Horner syndrome is a rare condition caused by a lesion of the sympathetic cervical chain. Multiple cervical disorders are associated with such lesions. Here we report the first case of Horner syndrome after cervical facet joint corticosteroid injection.

A review of Horner's syndrome in small animals.

Horner's syndrome arises from dysfunction of the oculosympathetic pathway and is characterized by miosis, enophthalmos, protrusion of the third eyelid, and ptosis. It has been recognized in a wide variety of breeds and ages in small animal patients. The oculosympathetic pathway is a 3-neuron pathway. The central/first order neuron arises from the hypothalamus and extends down the spinal cord. The preganglionic/second order neuron arises from the first 3 thoracic spinal cord segments and travels through the thorax and cervical region until it synapses at the cranial cervical ganglion. The postganglionic/third order neuron travels from this ganglion to the orbit. Topical application of cocaine is the gold standard for differentiating Horner's syndrome from other causes of miosis. Topical 1% phenylephrine allows for identification of a post-ganglion Horner's syndrome. Numerous etiologies have been reported for Horner's syndrome, but idiopathic disease is most common. Ancillary diagnostics include otoscopic examination, thoracic radiographs, or advanced imaging. Treatment and prognosis are determined by the etiology.

Examen du syndrome de Horner chez les petits animaux. Le syndrome de Horner provient d'une dysfonction de la voie oculo-sympathique et est caractérisée par la miose, l'enophtalmie, la protrusion de la troisième paupière et la ptose. Elle a été reconnue chez une grande variété de races et d'âges chez les patients petits animaux. La voie oculo-sympathique est une voie à trois neurones. Le neurone central/de premier ordre provient de l'hypothalamus et s'étend vers le bas sur la colonne vertébrale. Le neurone préganglionnaire/de deuxième ordre provient des trois premiers segments thoraciques de la colonne vertébrale et se déplace dans le thorax et la région cervicale jusqu'à la synapse au ganglion cervical crânien. Le neurone postganglionnaire/de troisième ordre se déplace de ce ganglion jusqu'à l'orbite. L'application topique de cocaïne est le test de référence pour la différenciation du syndrome de Horner des autres causes de miose. La phényléphrine topique 1 % permet l'identification d'un syndrome de Horner postganglionnaire. Plusieurs étiologies ont été signalées pour le syndrome de Horner, mais la maladie idiopathique est la plus commune. Les diagnostics auxiliaires incluent l'examen otoscopique, des radiographies thoraciques ou une imagerie avancée. Le traitement et le pronostic sont déterminés par l'étiologie.(Traduit par Isabelle Vallières).

Aplicación de toxina botulínica en el músculo de Horner para el tratamiento de ojo seco / Application of botulinum toxin in Horner's muscle for the treatment of dry eye

OBJETIVO/MÉTODOS: Describir el uso de toxina botulínica tipo A para aumentar la retención lagrimal en pacientes con ojo seco mediante el reporte de 2 casos. RESULTADOS: Pacientes con ojo seco moderado a severo, a quienes se les inyectaron 5 UI de toxina botulínica tipo A en el músculo de Horner. Se describen los resultados al mes y 3 meses. Se evaluó la percepción subjetiva del paciente en cuanto a la mejoría, además, del Ocular Surface Disease Index, la queratitis punteada superficial, el tiempo de rotura de la lágrima y el menisco lagrimal, los cuales también fueron tenidos en cuenta. Se evidenció una importante mejoría de la percepción subjetiva del paciente, el Ocular Surface Disease Index, la queratitis punteada superficial, el tiempo de rotura de la lágrima y el menisco lagrimal al mes de la aplicación, manteniéndose aún con buenos resultados al tercer mes. No se presentaron eventos adversos. DISCUSIÓN: El uso de toxina botulínica tipo A puede ser considerado una alternativa para aumentar la retención de la lágrima en pacientes con ojo seco moderado a severo con una buena respuesta durante el primer mes, manteniendo una respuesta aceptable incluso al tercer mes. Dado el efecto temporal del medicamento, podría precisar retratamientos

OBJECTIVE/METHODS: The aim of this study is to describe the use of botulinum toxin to increase tear retention in patients with dry eye, using the description of 2 cases. RESULTS: Patients with moderate to severe dry eye that were given an injection of type A botulinum toxin in the Horner's muscle. The results at one month and 3 months are reported. An assessment was made of the subjective perception of the patient as regards any improvement, as well as taking into account, the Ocular Surface Disease Index, superficial punctate keratitis, and the time of the tear rupture and tear meniscus. A significant improvement was observed in the subjective perception of the patient, the Ocular Surface Disease Index, superficial punctate keratitis, and the time of the tear rupture and tear meniscus at one month after treatment, and the good results still being maintained at the third month. There were no adverse events. DISCUSSION: The use of type A botulinum toxin can be considered as an alternative to increase tear retention in moderate to severe dry eye, with a good response during the first month, with an acceptable response still being maintained at the third month. Given the temporary effect of the drug, further treatments would be required

Horner syndrome as a complication after thyroid microwave ablation: Case report and brief literature review.

RATIONALE: Horner's syndrome (HS) can present as a complication of thyroid surgery, particularly after thyroid microwave ablation (MWA). HS presents clinically with eyelid ptosis, miosis, enophthalmos, anhidrosis, and vascular dilatation, all of which result from a damaged oculosympathetic chain. We aimed to try to avoid such devastating symptoms in future cases by exploring reasons for the destruction of the cervical sympathetic trunk. PATIENT CONCERNS: HS has previously been reported in the literature as a complication of thyroid surgery. Here, we report the case of a 44-year-old female patient who presented with miosis and eyelid ptosis following thyroid MWA. DIAGNOSES: This patient was subsequently diagnosed with HS. INTERVENTIONS: Mecobalamin was administered immediately. OUTCOMES: After 5 months of follow up, the patient's miosis and ptosis was incompletely relieved. LESSONS: Although HS is a rare complication of thyroid MWA, surgeons must be aware of the anatomic relationship of the cervical sympathetic trunk and thyroid gland with adjacent structures. Moreover, we hope this case presentation enables surgeons to take measures to minimize the possibility of oculosympathetic damage. Long-term follow up and comprehensive assessments are important for the patient's prognosis.

Lymphatic malformation with acquired Horner syndrome in an infant.

An infantpresented with right upper eyelid ptosis and was subsequently diagnosed with acquired Horner syndrome. Further evaluation revealed a right-sided cervicothoracic lymphatic malformation. At 13 weeks of age, the child underwent percutaneous intracystic sclerotherapy with a mixture of sodium tetradecyl sulphate and ethanol. Twenty-one weeks after initial treatment, ophthalmic examination showed complete resolution of the blepharoptosis and pupillary miosis. Percutaneous sclerotherapy not only effectively treated the space-occupying lymphatic malformation but also reversed the Horner syndrome that was presumably induced by neural tension (more likely) or compression.

Ptosis, miosis and cats.

Horner's syndrome (HS) is caused by a disruption in the oculosympathetic pathway. Both congenital and acquired HS are unusual in children. Acquired HS can be caused by trauma, surgical intervention, tumours, vascular malformations or infection.We describe the case of a 6-year-old boy who was brought to our emergency department with ptosis, miosis, painful cervical lymphadenopathy and a cat scratch on a hand. The diagnosis of a cat scratch disease was confirmed by serology. A full recovery was observed on antibiotic treatment and cervical lymphadenomegaly reduction 3 weeks later.

Apraclonidine in the treatment of ptosis.

Transient ptosis is a known complication of botulinum toxin (BoNT) injection due to inadvertent migration of toxin into the levator palpebrae superioris muscle. Currently there is no treatment available for BoNT induced ptosis. Apraclonidine hydrochloride is a topical ophthalmic solution with selective alpha-2 and weak alpha-1 receptor agonist activity that has the ability to elevate the eye lid. Apraclonidine has been used as a diagnostic test in Horner's syndrome. We evaluated the effects apraclonidine in a cohort of BoNT induced ptosis and a patient with Horner syndrome. Each patient was administered 2 drops of apraclonidine 0.5% solution to the eye with the ptosis and was re-examined 20-30min later. All 6 patients showed improvement in ptosis. There was also improvement in ptosis in a patient with Horner's syndrome. Apraclonidine is not only useful as a diagnostic test in Horner's syndrome, but may be an effective and safe treatment for BoNT-induced ptosis.

Horner syndrome as a postoperative complication after minimally invasive video-assisted thyroidectomy: A case report.

RATIONALE: Horner syndrome is an unusual complication after thyroidectomy. PATIENT CONCERNS: We report a case of Horner syndrome in a 34-year-old female patient with Graves disease associated with papillary thyroid carcinoma who underwent left-side minimally invasive video-assisted thyroidectomy and neck dissection. DIAGNOSIS: Horner syndrome was diagnosed based on left myosis, eyelid ptosis, and mild enophthalmos, which developed in the patient on postoperative day 2. INTERVENTIONS: The patient was administered glucocorticoids and neurotrophic drugs on postoperative day 3. OUTCOME: The symptoms of Horner syndrome were significantly relieved 1 year later. LESSONS: Surgeons must be aware that Horner syndrome may be a source of iatrogenic complications, and patients also should be informed of these complications before surgery.

The role of apraclonidine in Horner's syndrome ­ A case report.

Introduction: Horner's syndrome is an interruption of the sympathetic nervous system at any point along its course between the hypothalamus and the orbit. Horner's syndrome is classically presented as an ipsilateral miosis, subtle ptosis, and facial anhidrosis. Pharmacologic testing is very useful in the diagnosis of Horner's syndrome as it could help to localize the lesioned neuron in the sympathetic pathway, suggesting an etiology. Case Outline: We present a case report of a 41-year-old woman who reported right eyelid drooping immediately after operation of sympathetic chain schwannoma. We performed apraclonidine test for the diagnosis of Horner's syndrome, which produced mydriasis on the affected eye, while there was no significant change of the normal eye. Based on the clinical presentation of anisocoria and one-sided ptosis, and previous medical history of surgical removal of the mediastinal tumor, the patient was diagnosed with a right-sided, partial Horner's syndrome. Conclusion: Timely recognition, exact localization of the lesioned neuron, and referral for urgent imaging studies are important for ophthalmologists in order to prevent and treat life-threatening conditions. Besides its diagnostic value in Horner's syndrome, topical apraclonidine could correct ptosis for the sake of esthetics or when ptosis reduces the superior visual field.

Erythema migrans associated with partial Horner's syndrome.

Lyme disease is a tick-borne illness caused mainly by three species of spirochaete Borrelia--B. burgdorferi, B. afzelii and B. garinii. It has three stages of presentation--early localised, early-disseminated and late Lyme. Erythema migrans is the most common manifestation of Lyme disease, and is usually seen 7-14 days after the tick bite. Patients seldom remember the tick bite. Patients may often present with neurological manifestations indicating neuroborreliosis. These manifestations range from a simple nerve palsy to severe complications such as papilloedema, myelitis or meningitis. We present a case of a 37-year-old woman who presented with partial Horner's syndrome, which was associated with erythema migrans, and other signs of Lyme disease.

[A rare case of Horner's syndrome in pituitary apoplexy]. / Horners syndrom ved hypofyseapopleksi er sjælden.

Pituitary apoplexy is a rare but potentially life-threatening condition that is classically comprised of acute-onset severe headache accompanied by nausea and vomiting, visual field disturbances, external ophthalmoplegia, and often hypopituitarism. A case illustrating the highly variable clinical appearance of this condition is presented.

Naphazoline as a confounder in the diagnosis of carotid artery dissection.

Diagnosing Horner Syndrome can be difficult in the setting of an incomplete triad. A 27-year-old man presented with unilateral eyelid droop and intermittent ipsilateral headaches, having already seen 7 physicians. Physical examination revealed unilateral ptosis but no pupillary miosis or facial anhidrosis. Inspection of his clinical photographs revealed elevation of the ipsilateral lower eyelid, suggesting sympathetic dysfunction. On further questioning, he admitted to naphazoline dependence. Reexamination after ceasing the naphazoline unveiled the anisocoria. Vascular imaging subsequently revealed carotid dissection, and the patient was started on anticoagulant and antiplatelet therapy. The ptosis persisted after conjunctival Müllerectomy. External levator resection was recommended, but patient declined. This case underscores the importance of clinical photography, meticulous medical record review, and complete medication history including over-the-counter preparations. Clinicians should meticulously inspect the lower eyelid in cases of atypical blepharoptosis and consider the effects of eye drops when inspecting pupils for miosis.

Síndrome de Horner contralateral asociado a bloqueo de ganglio estrellado: reporte de caso y revisión de la literatura / Contralateral Horner's syndrome associated with stellate ganglion block: case report and literature review

Se describe un caso de síndrome de Horner contralateral luego de bloqueo de ganglio estrellado. Se trata de un varón de 56 años con diagnóstico de síndrome doloroso regional complejo tipo II en miembro superior derecho quien posterior a la aplicación de anestésico local guiado por ecografía en proximidad al ganglio estrellado derecho presenta síndrome de Horner izquierdo. El síndrome de Horner contralateral a un bloqueo de ganglio estrellado es una entidad de ocurrencia supremamente rara, en nuestra práctica se presentó uno de los pocos casos reportados en la literatura, de interés para la comunidad científica (AU)

We describe a case of contralateral Horner’s syndrome following stellate ganglion block. A 56 years old man diagnosed with complex regional pain syndrome type II in right upper arm, who developed after the application of local anesthetic guided by ultrasound in proximity to the right stellate ganglion presented left Horner’s syndrome. The contralateral Horner’s syndrome following stellate ganglion block is a rare entity. In our practice occurred one of the few cases reported in the literature, which is of great interest for the medical community (AU)