Materiały źródłowe

• #1 Horner syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/horner-syndrome/diagnosis-treatment/drc-20373551

  In addition to a general medical examination, your doctor will likely conduct tests to determine the nature of your symptoms and identify a possible cause. […] Your doctor may be able to diagnose Horner syndrome based on your history and an assessment of your symptoms. […] An eye specialist (ophthalmologist) may also confirm a diagnosis by putting a medicated eye drop in both eyes either a drop that will dilate the pupil of a healthy eye or a drop that will constrict the pupil in a healthy eye. By comparing the reactions in the healthy eye with that of the suspect eye, the doctor can determine whether nerve damage is the cause of problems in the suspect eye. […] The nature of your symptoms may help your doctor narrow the search for the cause of Horner syndrome. Your doctor may also conduct additional tests or order imaging tests to locate the lesion or irregularity disrupting the nerve pathway.

• #2 Horner Syndrome: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17836-horners-syndrome

  Horner syndrome is a rare neurological syndrome that affects your eye and the surrounding area on one side of your face. […] Seek medical care if you develop Horner syndrome. […] The symptoms associated with Horner syndrome generally dont cause significant issues with your health or vision. However, they can indicate the presence of an underlying health problem that may be very serious. Its important to seek medical care if you develop symptoms of Horner syndrome to determine the underlying cause. […] Healthcare providers usually diagnose Horner syndrome with a physical exam. Determining the underlying cause may be complex, as it can occur due to many medical conditions. In addition, other conditions can cause similar symptoms. […] Based on your medical history and any other symptoms you have, a provider may order additional tests to determine the cause of Horner syndrome, including: Imaging tests, such as a chest X-ray, magnetic resonance imaging (MRI), computed tomography (CT scan) or ultrasound.

• #3 Horner Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK500000/

  Horner syndrome is a rare condition classically presenting with partial ptosis (drooping or falling of the upper eyelid), miosis (constricted pupil), and facial anhidrosis (absence of sweating) due to a disruption in the sympathetic nerve supply. […] Treatment is centered around the identification and appropriate management of the underlying cause. […] This activity reviews the evaluation and management of Horner syndrome and highlights the role of the interprofessional team in the management of affected patients. […] Therefore, treatment is centered around identifying and appropriate management of the underlying secondary cause. […] Localization of the lesion in Horner syndrome is crucial in subsequent management. A detailed history and physical examination are, therefore, of vital importance.

• #4 Horner Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK500000/

  A detailed examination of the eyes is warranted and should include the following: reactivity of the pupils to light and accommodation, measurement of pupillary diameter in dim and bright light, examination of the upper eyelid for ptosis and fatigability, evaluation of extraocular movements, vision, including color vision and visual fields, slit-lamp examination for structural details, evaluation of the presence of nystagmus. […] The initial workup should include a complete blood count (CBC), erythrocyte sedimentation rate (ESR), and serum chemistry panel. […] This is the most helpful testing modality for diagnostic localization. […] Treatment options are based on the diagnosis and management of the underlying cause. Timely diagnosis is of critical importance, followed by referral to an appropriate specialist.

• #5 Horner’s syndrome – Case-Based Neuro-Ophthalmology

  https://pressbooks.pub/casebasedneuroophthalmology/chapter/horners-syndrome/

  When a patient presents with anisocoria (different pupil sizes), the most important next step is to determine which pupil is abnormal. This can be determined by measuring the degree of anisocoria in bright and dim light. If the difference is greater in dim light, the small pupil is abnormal. The differential diagnosis for this situation includes Horners syndrome (oculosympathetic paresis) […] The signs of Horners syndrome include ptosis of the upper and lower eyelids (the upper lid is at lower position and the lower lid is a higher position), miosis and dilation lag. Dilation lag is impaired pupillary movement during dilation. After the lights are turned off, there is an initial increase in the anisocoria as the normal pupil is stimulated by a burst of sympathetic activity, but the Horner pupil, devoid of sympathetic impulses, hardly moves. The Horner pupil later catches up as parasympathetic tone decreases.

• #6 Horner Syndrome – EyeWiki

  https://eyewiki.org/Horner_Syndrome

  Horner’s syndrome is a clinical diagnosis. Pharmacological confirmation tests can be performed in subtle cases. […] Horner’s syndrome can be established clinically by an ocular examination. A targeted physical and neurological examination is a must to identify signs that may help localize the lesion and guide appropriate investigations. […] Horner’s syndrome is diagnosed clinically by observing ptosis (of upper and lower lids), miosis of the ptotic eye and demonstration of dilation lag in the affected eye, and anhidrosis on the same side as the ptosis and/or mitosis. […] Topical Cocaine may be used to confirm Horner’s syndrome in subtle cases. Cocaine blocks reuptake of the neurotransmitter norepinephrine from the synaptic cleft and will cause dilation of the pupil with intact sympathetic innervation.

• #7 Horner Syndrome: Pharmacologic Diagnosis — Ophthalmology Review

  https://www.ophthalmologyreview.org/articles/horner-syndrome-pharmacologic-diagnosis

  Horner syndrome describes the constellation of findings associated with a lesion affecting the oculosympathetic pathway. Clinically, ipsilateral miosis, ptosis, and anhidrosis form the classic triad, with other features potentially being present. […] Despite these changes to practical clinical evaluation, it remains clinically important to understand the pharmacologic principles involved in the diagnosis of Horner syndrome. […] The pharmacologic diagnosis of Horner syndrome can be broken into two major categories: Confirming the diagnosis of Horner syndrome and Localizing Horner syndrome to preganglionic (1st-/2nd-order) or postganglionic (3rd-order) neuron. […] The cocaine test for Horner syndrome is often tested in board exam/OKAP settings, most likely because of its understood mechanism of action, its contribution to the understanding/diagnosis of Horner syndrome, and somewhat counterintuitive testing results. […] Apraclonidine is the most readily available drug used for confirming Horner syndrome. […] Hydroxyamphetamine remains a useful tool for localization of the lesion once a diagnosis of Horner syndrome has been confirmed.

• #8 Help with Horner’s

  https://www.reviewofoptometry.com/article/help-with-horners

  New onset right ptosis (with miosis) in a patient who presented with Horners syndrome secondary to a Pancoast tumor. […] This all pointed to a dysfunction within the sympathetic nervous system, namely the oculosympathetic plexus. Clearly, she had a new onset of Horners syndrome. […] The diagnosis and localization of Horners syndrome can be accomplished with pharmacological testing. […] Cocaine is a sympathomimetic drug which acts indirectly to prevent reuptake of endogenously released norepinephrine from the sympathetic nerve terminal. […] The Horners pupil will dilate poorly compared to the normal eye because of the sympathetic dysfunctional absence of norepinephrine at the nerve ending. So, either poor or no dilation with cocaine is indicative of Horners syndrome. […] To identify the lesion as being central or pre-ganglionic (neurons 1 or 2 before the synapse in the superior cervical ganglion) or post-ganglionic (after exiting the superior cervical ganglion), Paredrine hydroxyamphetamine 1% can be subsequently used 72 hours later.

• #9 Horner’s Syndrome | Ento Key

  https://entokey.com/horners-syndrome/

  Cocaine blocks the reuptake of norepinephrine into the sympathetic nerve endings, making this neuro-transmitter more available at the motor end plate. […] In a normal eye, two drops of a 10% cocaine solution cause dilation of the pupil, maximally noticed after 45 to 60 minutes in dim lighting. […] In a sympathetically denervated pupil no dilation occurs. […] Although traditionally one looks for at least a 1-mm increase in anisocoria from the drops, in skilled hands it is unnecessary to compare the anisocoria before and after cocaine instillation, because a postcocaine anisocoria of 0.8 mm is sufficient to diagnose a Horners syndrome. […] Postganglionic (third-order) Horners syndrome is differentiated from preganglionic (first- or second-order) Horners syndrome by the hydroxyamphetamine test.

• #10 Pharmacological testing in Horner’s syndrome: a new paradigm

  http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010001100020

  For more than three decades, topical cocaine has been used to confirm the diagnosis and hydroxyamphetamine to localise the causative lesion in oculosympathetic palsy or Horner’s syndrome. […] Recently, however, other drugs have been studied that assist in diagnosing or localising the lesion. These include pholedrine, apraclonidine, adrenaline and phenylephrine. […] The exact sensitivity of apraclonidine in the diagnosis of Horner’s syndrome remains uncertain, largely owing to small sample sizes. […] Cocaine and apraclonidine are both useful in confirming the diagnosis of OSP, but cannot distinguish between pre- and postganglionic causes of the syndrome. […] It seems that apraclonidine 0.5% or 1% is a suitable alternative to cocaine in confirming the diagnosis of OSP, and that phenylephrine 1% is a reliable and readily available alternative to hydroxyamphetamine.

• #11 Horner Syndrome – EyeWiki

  https://eyewiki.org/Horner_Syndrome

  Topical Apraclonidine is an alternative to topical cocaine to confirm Horner’s syndrome. Apraclonidine is an alpha adrenergic agonist. […] Topical Hydroxyamphetamine is used to differentiate pre and postganglionic Horner’s. Hydroxyamphetamine causes a release of norepinephrine from intact adrenergic nerve endings causing pupillary dilation.

• #12 Horner syndrome: clinical perspectives | EB

  https://www.dovepress.com/horner-syndrome-clinical-perspectives-peer-reviewed-fulltext-article-EB

  Horner syndrome consists of unilateral ptosis, an ipsilateral miotic but normally reactive pupil, and in some cases, ipsilateral facial anhidrosis, all resulting from damage to the ipsilateral oculosympathetic pathway. […] We emphasize that pharmacologic testing can confirm its presence and direct further testing and management. […] The diagnosis of Horner syndrome should be considered in any patient with anisocoria associated with what appears to be normal pupillary constriction to light in both the larger and smaller pupil. […] Pharmacological testing using several agents can establish the diagnosis of a Horner syndrome in most cases and can also be used to localize the lesion. […] Cocaine is highly effective in confirming the diagnosis of Horner syndrome. […] Apraclonidine is an alpha-2 adrenergic agonist that is sometimes used to lower intraocular pressure in patients with glaucoma; however, it also has a weak alpha-1 adrenergic effect.

• #13 Atlas Entry – Apraclonidine Drop Testing for Horner Syndrome

  https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/apraclonidine-test-for-horners/index.htm

  Horner syndrome is a constellation of findings with notable features of ipsilateral ptosis, miosis, and anhydrosis. The anisocoria is typically larger in dimly lit conditions. To confirm the diagnosis with pharmacological testing, the first step is to use apraclonidine 0.5% or cocaine eye drops in both eyes. First we obtain baseline photos in dim light. […] The diagnosis of Horner syndrome is supported when there is reversal of the anisocoria as seen in these photos. This is the result the alpha-2 agonist effect of apraclonidine on the normal pupil and the dominant alpha-1 effect from adrenergic receptor supersensitivity in the Horner pupil, which takes 2 to 5 days to develop. The ptosis is also reversed with apraclonidine and this effect is seen within 5 minutes of administering the apraclonidine drops, owing to the rapid penetration through the conjunctiva to gain access to Mueller’s muscle. […] The next step of our testing algorithm, if the apraclonidine test is positive, is to perform localization to the preganglionic or postganglionic location by testing with hydroxyamphetamine 1%.

• #14 Horner’s Syndrome Following COVID-19 Infection and Treatment | Published in CRO (Clinical & Refractive Optometry) Journal

  https://clinicaloptometry.scholasticahq.com/article/36745-horner-s-syndrome-following-covid-19-infection-and-treatment

  Horners syndrome occurs secondary to paresis of the oculo-sympathetic pathway and classically presents with the triad of ptosis, miosis, and anhidrosis. […] A diagnosis of Horners syndrome was confirmed with pharmacological testing, and further evaluation identified the underlying etiology. […] Based on the presence of left upper lid ptosis and pupil miosis, diagnostic testing for suspected Horners syndrome was initiated. […] Upon re-evaluation, the ptosis of the left upper lid was almost completely resolved and the previously miotic left pupil was dilated, confirming our suspicion of Horners syndrome. […] Confirmation of suspected Horners syndrome can be achieved with ophthalmic pharmacological testing. […] The preferred agent for pharmacological testing is 0.5% apraclonidine ophthalmic solution.

• #15 Horner’s Syndrome Following COVID-19 Infection and Treatment | Published in CRO (Clinical & Refractive Optometry) Journal

  https://clinicaloptometry.scholasticahq.com/article/36745-horner-s-syndrome-following-covid-19-infection-and-treatment

  Horners syndrome is confirmed if the anisocoria reverses (i.e. the smaller pupil will become larger in size than the fellow eye). […] Identifying the exact cause of a Horners syndrome may entail extensive testing due to the large anatomic area encompassed by the sympathetic pathway. […] Once the diagnosis of Horners syndrome is confirmed with ophthalmic pharmacological testing, it is important to uncover the underlying cause in a timely manner, as certain etiologies of Horners syndrome can prove fatal if untreated.

• #16 Help with Horner’s

  https://www.reviewofoptometry.com/article/help-with-horners

  If the Horners pupil does dilate upon Paredrine instillation, the third neuron is healthy, and the damage involves either the first or second neuron; this condition is considered a pre-ganglionic Horners syndrome. […] Unfortunately, these drugs (cocaine and hydroxyamphetamine) are not available for clinical practice; however, it appears that the intraocular pressure lowering drug apraclonidine (0.5% and 1% Iopidine, Alcon) is a viable option. […] Pupil dilation in suspected cases of Horners syndrome is considered diagnostic. […] It appears that the most readily available agent, Iopidine 0.5%, is at least as sensitive and specific in the diagnosis of Horners syndrome as cocaine.

• #17 EyeRounds.org: Horner’s Syndrome with Cluster Headache

  http://eyerounds.org/cases/case22.htm

  Horner’s Syndrome (due to Cluster Headache): […] A cocaine test was done to confirm the suspected diagnosis of Horner’s Syndrome. […] This positive cocaine test confirmed the diagnosis of Horner’s Syndrome in our patient. […] To further evaluate where in the neuronal pathway the sympathetic nerves are being affected (i.e., 1st order, 2nd order, or 3rd order), the hydroxyamphetamine test was performed. […] Hydroxyamphetamine forces active release of stored norepinephrine from the presynaptic nerve ending which will cause dilation of either pupil as long as the 3rd order neuron is intact. […] In this case, his pupil did not respond to hydroxyamphetamine, confirming 3rd order neuron involvement. […] However, there is some discussion about the appropriate work-up for any new new-onset Horners syndrome.

• #18 Horner’s Syndrome | Ento Key

  https://entokey.com/horners-syndrome/

  This test should be performed at least 48 hours after cocaine instillation to ensure maximal sensitivity. […] Hydroxyamphetamine releases norepinephrine from stores in the nerve endings, resulting in mydriasis in a normal pupil. […] After ~2 weeks of postganglionic denervation the nerve endings are destroyed, so that no mydriasis is produced in response to hydroxyamphetamine instillation. […] After this period of denervation, a postganglionic Horners pupil develops denervation supersensitivity and dilates more than its fellow normal pupil in response to a weak adrenergic drop such as 1% phenylephrine.

• #19 Horner’s syndrome in dogs: aetiology and diagnostic protocol | Vets & Clinics

  https://vetsandclinics.com/en/horners-syndrome-in-dogs-aetiology-and-diagnostic-protocol

  Apraclonidine (0.51%) is used in human medicine to diagnose Horners syndrome. […] Phenylephrine or topical adrenaline is administered to determine the location of the lesion. […] The application of 0.1 mL of 0.001% adrenaline causes the affected pupil to dilate in the first 20 minutes for postganglionic cases, whereas it takes 30-40 minutes in healthy animals or animals with preganglionic Horners syndrome. […] If the test is performed with 10% phenylephrine, mydriasis is evident after 5-8 minutes with a postganglionic lesion, but there is no effect on normal eyes or eyes with a preganglionic lesion. […] The use of 1% hydroxyamphetamine has been proposed as a means of distinguishing between preganglionic/central and postganglionic Horners syndrome. […] Although the clinical signs of Horners syndrome in dogs are easily recognised, it is important to rule out other possible diagnoses first in a patient with anisocoria.

• #20 Horner syndrome: clinical perspectives | EB

  https://www.dovepress.com/horner-syndrome-clinical-perspectives-peer-reviewed-fulltext-article-EB

  Hydroxyamphetamine is useful in distinguishing central and preganglionic lesions from postganglionic ones. […] Some authors believe that a Horner syndrome can be localized not only with hydroxyamphetamine but also with a 1% solution of phenylephrine or a 2% solution of epinephrine. […] Once the diagnosis of a Horner syndrome has been confirmed, an appropriate evaluation should be performed. […] In adults with an acquired Horner syndrome, a simple x-ray of the neck in flexion and extension can identify cervical spondylosis, a common cause of both central and preganglionic Horner syndromes. […] The physician who diagnoses a possible Horner syndrome must carefully assess the patient for other neurologic manifestations that may help confirm the diagnosis and be helpful in localizing the site of injury.

• #21 Efficacy of digital pupillometry for diagnosis of Horner syndrome | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0178361

  To evaluate the efficacy of digital pupillometry in the diagnosis of anisocoria related to Horner syndrome in adult patients. […] The PLR parameters in the affected eye and inter-eye difference before and after 0.5% apraclonidine instillation. […] In the Horner group, pupil diameters and T75 showed significant difference between the affected eye and unaffected contralateral eye at baseline (all P0.00625). Compared to controls, inter-eye difference values of pupil diameters and T75 were significantly larger in the Horner group (all P0.001). […] The diagnostic criteria for Horner syndrome relying on baseline pupillary measurements was defined as one of the two major findings; 1) smaller maximal pupil diameter in the affected eye with an inter-eye difference of 0.5 mm, or 2) T75 2.61 seconds in the affected eye, which showed a sensitivity of 94.7% and specificity of 93.3%.

• #22 Efficacy of digital pupillometry for diagnosis of Horner syndrome | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0178361

  Digital pupillometry is an objective method for quantifying PLR. Baseline inter-eye difference in maximal pupil sizes and dilation lag measured by T75 was equally effective in the diagnosis of Horner syndrome compared to the reversal of anisocoria after apraclonidine instillation. […] The mydriatic effect which is observed in the affected eye of Horner syndrome is explained by upregulation of the 1 adrenergic receptors on iris dilator muscles in the absence of the normal sympathetic tone. […] The diagnostic sensitivity was highest when one of the two major findings were satisfied; 1) smaller maximal pupil size in the affected eye with an inter-eye difference of 0.5 mm, or 2) T75 2.61 sec in the affected eye.

• #23 Adult Horner’s syndrome: a combined clinical, pharmacological, and imaging algorithm | Eye

  https://www.nature.com/articles/eye2012281

  The diagnosis of Horners syndrome (HS) can be difficult, as patients rarely present with the classic triad of ptosis, miosis, and anhydrosis. […] Establishing the diagnosis begins with a detailed clinical history with use of adjunctive pharmacological testing and diagnostic imaging. […] With the variety of clinical presentations, pharmacological testing agents, and recent advances in diagnostic imaging, as well as the variable provision of these resources with different health-care infrastructures, there is a need for a clear combined clinical, pharmacological, and imaging guide to the investigative process in HS. […] Imaging plays an important role in the diagnosis of an underlying cause of HS, particularly in the absence of localising signs, especially pathologies that carry a substantial morbidity and mortality. […] Our proposed protocol provides a simple combined clinical, pharmacological, and imaging algorithm that is applicable to most institutions.

• #24 Adult Horner’s syndrome: a combined clinical, pharmacological, and imaging algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3597883/

  The diagnosis of Horner’s syndrome (HS) can be difficult, as patients rarely present with the classic triad of ptosis, miosis, and anhydrosis. […] Establishing the diagnosis begins with a detailed clinical history with use of adjunctive pharmacological testing and diagnostic imaging. […] Imaging plays an important role in the diagnosis of an underlying cause of HS, particularly in the absence of localising signs, especially pathologies that carry a substantial morbidity and mortality. […] Our proposed protocol provides a simple combined clinical, pharmacological, and imaging algorithm that is applicable to most institutions. […] The algorithm targets the specific pathologies and anatomical sites, matching it with the best available modality for assessment and diagnosis.

• #25 Horner syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/horner-syndrome/diagnosis-treatment/drc-20373551

  Your doctor may administer a type of eye drop that will significantly dilate the healthy eye and little dilation of the affected eye if Horner syndrome is caused by a third-order neuron irregularity a disruption somewhere in the neck or above. […] Your doctor may order one or more of the following imaging tests to locate the site of a probable irregularity causing Horner syndrome: Magnetic resonance imaging (MRI), a technology that uses radio waves and a magnetic field to produce detailed images; Magnetic resonance angiography (MRA), which is used to evaluate blood vessels; Chest X-ray; Computerized tomography (CT), a specialized X-ray technology.

• #26 The Radiology Assistant : Horner syndrome.

  https://radiologyassistant.nl/neuroradiology/horners-syndrome

  Horner syndrome is a rare clinical condition presenting with partial ptosis, miosis and facial anhidrosis described in 1869 by Johann Friedrich Horner. […] The clinical symptoms allow the anatomic location of the underlying pathology somewhere in the oculosympathetic pathway. Imaging plays an important role in the final diagnosis. […] Clinically it can be difficult to differentiate a central Horner from a pre- or postganglionic Horner. Pharmacological testing of the eyes with Apraclonidine or Cocaine can help make the diagnosis. […] Only in patients with a bilateral Horner we can assume, that the pathology is located in the central neuron. […] Interruption of oculosympathetic pathways leads to inactivation of the superior tarsal muscle resulting in ptosis and inactivation of the dilator muscle producing a miosis.

• #27 The Radiology Assistant : Horner syndrome.

  https://radiologyassistant.nl/neuroradiology/horners-syndrome

  Pre- and postganglionic causes of Horner syndrome are as common. Central Horner syndrome is uncommon. […] Brainstem signs suggest a brainstem localization and indicates MRI of the brain. Myelopathic features suggests involvement of the cervicothoracic cord and indicates MRI of the cervical spine and/or brachial plexus. […] The most common cause of a central Horner is infarction of the posterior-inferior cerebellar artery or of the distal vertebral artery territory and is part of the lateral medullary syndrome. […] Preganglionic Horner syndrome is a common cause of Horner syndrome and most often caused by tumor or trauma. […] Patients with preganglionic Horner’s syndrome often present with the classic triad: ptosis, miosis, anhidrosis and sometimes in combination with brachial plexopathy.

• #28 Imaging for Horner syndrome: Balancing cost with diagnostic accuracy

  https://www.ophthalmologytimes.com/view/imaging-horner-syndrome-balancing-cost-diagnostic-accuracy

  A single contrast-enhanced brain magnetic resonance imaging extending to the level of T2 in the chest and pharmacologic confirmation without localization seems appropriate to identify lesions in patients with Horner syndrome. […] However, there is no current consensus on the best way to ferret out the underlying etiology. […] The conventional approach to evaluating a patient with Horner syndrome has been a clinical and pharmacologic assessment with localization of the lesion. […] Chen recommended performing a single contrast head and neck MRI to the level of T2 in the chest for Horner syndrome. […] We no longer rely on pharmacologic localization before imaging and all patients received the same protocol, she said. […] Furthermore, she pointed out that all 27 patients in her study were found to have an etiology and patients with a negative MRI did not develop a new etiology during the follow-up period for Horner syndrome.

• #29 Imaging for Horner syndrome: Balancing cost with diagnostic accuracy

  https://www.ophthalmologytimes.com/view/imaging-horner-syndrome-balancing-cost-diagnostic-accuracy

  In summary, that protocol involves three steps: a clinical diagnosis of Horner syndrome, pharmacologic confirmation with no need for localization, and a single contrast-enhanced brain MRI extending to the level of T2 in the chest. […] We make the diagnosis of Horner syndrome clinically and do not currently use the hydroxyamphetamine drops to pharmacologically localize or direct our neuroimaging study to the pre- or post-ganglionic oculosympathetic pathway, he said.

• #30 The Radiology Assistant : Horner syndrome

  https://radiologyassistant.nl/head-neck/horners-syndrome-1

  An acute isolated Horner syndrome with headache or neck pain is a carotid dissection until proven otherwise and MRA or CTA of the head and neck is needed. […] In these patients the Horner can resolve when the hematoma minimizes, as was the case in this patient after treatment with antiplatelet agents. […] CT and MRI can be complementary, but CT is preferred in the acute setting and for evaluation of vascular and osseous injury and pulmonary mass. MRI is preferred for imaging of the brain and spinal cord.

• #31 Horner syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/horner-syndrome?lang=us

  Horner syndrome classically presents as an ipsilateral enophthalmos, blepharoptosis, pupillary miosis and facial anhidrosis due to disruption at some point of the oculosympathetic pathway. […] Ptosis is due to interruption of the sympathetic motor innervation of the superior tarsal muscle which is a small muscle composed of smooth muscle fibers intimately associated with the undersurface of levator palpebrae superioris muscle. […] Horner syndrome can be anatomically classified into three types, depending on where the pathology affects the sympathetic pathway. […] Interestingly, postganglionic lesions do not tend to present with anhidrosis, as opposed to central or preganglionic lesions. […] The main ones include central causes, pre-ganglionic causes, and post-ganglionic causes. […] Selective MR imaging approach for evaluation of patients with Horner’s syndrome.

• #32 The Radiology Assistant : Horner syndrome.

  https://radiologyassistant.nl/neuroradiology/horners-syndrome

  For pathology causing postganglionic Horner syndrome we have to study the internal and external carotid artery, skullbase, cavernous sinus, orbital apex and the eye. […] An acute isolated Horner syndrome with headache or neck pain is a carotid dissection until proven otherwise and MRA or CTA of the head and neck is needed. […] In these patients the Horner can resolve when the hematoma minimizes, as was the case in this patient after treatment with antiplatelet agents.

• #33 Horner Syndrome: Overview, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1220091-overview

  In general, laboratory studies do not play a significant role in the diagnosis and management of Horner syndrome. However, depending on the localization and suspected etiology, certain laboratory tests may be considered, as follows: Urine test (ie, vanillylmandelic acid [VMA] and homovanillic acid [HVA]) in pediatric Horner syndrome to rule out neuroblastoma. […] Imaging studies may be ordered in conjunction with appropriate medical or surgical consultation, depending on the localization and suspected etiology. […] Pharmacologic testing is very helpful in the diagnosis of Horner syndrome. The following pharmacologic tests document the presence or absence of an ocular sympathetic lesion and identify the level of involvement (ie, preganglionic or postganglionic). Localizing the lesion is important because preganglionic lesions are associated with a higher incidence of malignancy that necessitates extensive investigations.

• #34 Horner syndrome: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000708.htm

  Horner syndrome is a rare condition that affects the nerves to the eyes and face. […] Your health care provider will perform a physical exam and ask about the symptoms. […] An eye exam may show: Changes in how the pupil opens or closes, Constricted pupil, Eyelid drooping, Red eye. […] Depending on the suspected cause, tests may be done, such as: Blood tests, Blood vessel tests of the head (angiogram), Chest x-ray or chest CT scan, MRI or CT scan of the brain or cervical spine, Spinal tap (lumbar puncture), Electromyography and nerve conduction studies if nerve root or brachial plexus injury is suspected. […] You may need to be referred to a provider who specializes in vision problems related to the nervous system (neuro-ophthalmologist).

• #35 Horner’s syndrome – Case-Based Neuro-Ophthalmology

  https://pressbooks.pub/casebasedneuroophthalmology/chapter/horners-syndrome/

  Carotid artery dissection can disrupt the sympathetic fibers ascending around the wall of the internal carotid artery leading to an ipsilateral Horners syndrome. In a patient presenting with an acute Horners syndrome with neck or head pain, carotid dissection must be urgently ruled out. […] The patient had a CTA of the head and neck and a right carotid artery dissection was seen (red arrow). […] Final diagnosis: Right Horners syndrome secondary to a right internal carotid artery dissection. […] Patients with congenital Horners syndrome have miosis, ptosis, facial anhydrosis and hypochromia of the affected iris. […] Acquired Horners syndrome in a child may be the presenting sign of neuroblastoma, which is a malignant neuroendocrine tumor of the sympathetic nervous system. Children presenting with Horners syndrome without a known diagnosis require further investigations to exclude a neoplastic process such as neuroblastoma.

• #36 Horner’s syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Horner%27s_syndrome

  Horner’s syndrome, also known as oculosympathetic paresis, is a combination of symptoms that arises when a group of nerves known as the sympathetic trunk is damaged. […] Once the syndrome has been recognized, medical imaging and response to particular eye drops may be required to identify the location of the problem and the underlying cause. […] Three tests are useful in confirming the presence and severity of Horner syndrome: […] Cocaine drop test: Cocaine eyedrops block the reuptake of post-ganglionic norepinephrine resulting in the dilation of a normal pupil from retention of norepinephrine in the synapse. […] Paredrine test: This test helps to localize the cause of the miosis. […] It is important to distinguish the ptosis caused by Horner’s syndrome from the ptosis caused by a lesion to the oculomotor nerve. […] When anisocoria occurs 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 on the side of the ptosis.

• #37 Horner syndrome DDx • LITFL • CCC Differential Diagnosis

  https://litfl.com/horner-syndrome-ddx/

  The features of Horner syndrome are: Mild ptosis paresis of Mller muscle (absent on upward gaze due to intact CN3 function) […] Miosis paralysis of pupillary dilator muscle […] Ipsilateral anhidrosis […] Apparent enophthalmos […] Heterochromia iridis may be present in congenital Horner syndrome […] Lower eyelid reverse ptosis […] The eye may appear slightly bloodshot due to loss of vasoconstrictor activity in the vessels of the bulbar conjunctiva. […] The potential causes are numerous and fall into 3 categories: Central lesions (expect anhydrosis of the upper forequarter and coexistent neurological deficits) […] Preganglionic lesions […] Postganglionic lesions (may not affect sweating main sympathetic outflow to facial vessels and sweat glands is from below the superior cervical ganglion). […] Postganglionic lesions (may not affect sweating main sympathetic outflow to facial vessels and sweat glands is from below the superior cervical ganglion).

• #38 Horner’s Syndrome: What Optometrists Should Know

  https://eyesoneyecare.com/resources/horners-syndrome-what-optometrists-should-know/

  Note that children who were not born with Horners can still develop the condition, often from trauma or malignancies, so it is imperative to ask about the childs birth history and perform a detail-oriented clinical exam on the child. […] A careful clinical examination is also necessary in suspected Horners Syndrome. As always, start with a good visual acuity measurement. Measure pupil sizes in dim and bright illumination and check pupil reactivity to light and accommodation prior to instilling any topical drops. […] Once you suspect an undiagnosed Horners syndrome based on the patients clinical exam and their history, you need to start thinking about referral. […] We can identify these areas of damage using topical eye drops. We first use topical pharmacologic agents to determine the presence of Horners Syndrome. Cocaine (yes, cocaine) drops instilled in the eye will normally cause the pupil to dilate.

• #39 What is Horner Syndrome – Horner Syndrome in Children

  https://www.childbirthinjuries.com/birth-injury/horners-syndrome/

  Other potential diagnostic tests include: Carotid ultrasound, CT scan (computed tomography), MRI (magnetic resonance imaging), X-ray. […] For children born with congenital Horner syndrome, studies have shown that the most important indicator is whether they potentially suffered trauma during a difficult birth. If it can be proven that the child suffered birth trauma, then extensive systematic testing may not be needed as long as their symptoms do not worsen. […] Since Horner Syndrome is caused by underlying issues, it is important to act quickly to discover the source of the problem. Symptoms may worsen if the damage goes untreated.

• #40 Horner Syndrome in Children — Pediatric EM Morsels

  https://pedemmorsels.com/horner-syndrome-in-children/

  Horner Syndrome can be Congenital or Acquired. […] Congenital causes are likely to be mechanical stress placed on the neck/carotid sheath. […] New onset Horner Syndrome? Gotta think of neuroblastoma. […] Evaluation: No consensus recommendations exist. […] Obtain thorough birth history and surgical history. […] Thorough physical exam looking specifically for neck or abdominal masses. […] Obtain spot urine catecholamine metabolites. […] Imaging of the neck and chest and maybe head and abdomen. […] If story is consistent with forceful manipulation of an infant’s neck during delivery, may be able to avoid extensive imaging, but otherwise need to look for neuroblastoma. […] CT imaging is sensitive for neuroblastoma. […] MRI does have superior resolution of paravertebral structures. […] Given difference between adults and children, do not typically need to image the vasculature in children.

• #41 Horner syndrome | MedLink Neurology

  https://www.medlink.com/articles/horner-syndrome

  The authors provide an updated clinical review of Horner syndrome. The most current recommendations regarding pharmacologic diagnosis and radiographic evaluation are highlighted. Important issues regarding the evaluation of Horner syndrome in children are also reviewed. […] When the cause is not obvious, pharmacologic testing with topical apraclonidine 0.5% should be performed to confirm the diagnosis of Horner syndrome, as there are other causes of ptosis and miosis. […] When there are no localizing clues, MRI/MRA or CT/CTA should scan from the skull base to the mid-thoracic region. […] Diagnosis should be confirmed via pharmacologic testing with apraclonidine 0.5% in patients older than 2 years and cocaine 10% in those under that age. […] Reversal of anisocoria following apraclonidine instillation is specific for Horner syndrome. […] Imaging can be omitted if the location and cause are obvious. Otherwise, imaging should be targeted at sites identified by localizing features. If there are no localizing features, imaging must span from the angle of the jaw to the upper thoracic spine.

• #42 Traumatic Horner Syndrome – EyeWiki

  https://eyewiki.org/Traumatic_Horner_Syndrome

  Pharmacologic testing with topical cocaine, apraclonidine, hydroxyamphetamine, or phenylephrine may be helpful in confirming the presence of Horner syndrome or locating which order nerve is involved. […] The presence of concomitant ptosis with pupillary miosis should place Horner syndrome high on the differential, particularly if accompanied by anhidrosis. […] In the setting of trauma, a thorough history obtained from all available sources (patient, family, witnesses, first responders, etc.) focused on the mechanism of action, along with any relevant neurological and ophthalmic history, may help to guide further workup, radiological studies, and consultation. […] Acute onset of Horner syndrome should be evaluated immediately to further prevent trauma-associated injury and, specifically, to prevent stroke secondary to an internal carotid artery dissection. […] Horner syndrome results from disruption of the oculosympathetic pathways, and is associated with ptosis, miosis, and anhidrosis, although patients may not present with this complete triad.

• #43 Horner Syndrome | Concise Medical Knowledge

  https://www.lecturio.com/concepts/horner-syndrome/

  Topical apraclonidine is used as an alternative agent to confirm Horner syndrome. […] A reversal of anisocoria after the application of 2 drops of 0.5% apraclonidine is suggestive of Horner syndrome. […] Topical hydroxyamphetamine is used to differentiate 1st-order and 2nd-order Horner syndrome from 3rd-order Horner syndrome. […] Imaging is used in conjunction with medical tests to confirm the etiology and locate the site of the lesion. […] MRI of the brain and spinal cord is indicated in cases with signs indicative of central nervous system lesions. […] The acute painful onset of Horner syndrome should be considered a medical emergency, as it might indicate a carotid artery dissection.

• #44 Horner Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23000

  Horner syndrome is primarily an acquired condition secondary to systemic/local diseases or iatrogenic causes but may be congenital and purely hereditary in some rare cases. […] The causes of Horner syndrome can be divided according to the anatomical location of disruption. […] Localization of the lesion in Horner syndrome is crucial in subsequent management. A detailed history and physical examination are, therefore, of vital importance. […] The initial workup should include a complete blood count (CBC), erythrocyte sedimentation rate (ESR), and serum chemistry panel. […] This is the most helpful testing modality for diagnostic localization. […] Treatment options are based on the diagnosis and management of the underlying cause. Timely diagnosis is of critical importance, followed by referral to an appropriate specialist. […] For the appropriate management of Horner syndrome and the underlying cause, the following consultations may be needed: Pulmonology, Neurology, Neurosurgery, Interventional radiology, Oncology, Neuro-ophthalmology. […] The long-term prognosis of idiopathic Horner syndrome appears to be benign.

• #45 Horner Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK500000/

  For the appropriate management of Horner syndrome and the underlying cause, the following consultations may be needed: pulmonology, neurology, neurosurgery, interventional radiology, oncology, neuro-ophthalmology. […] Patients should be educated about the possible presentations of Horner syndrome.

• #46 Horner Syndrome: Overview, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/1220091-overview

  In general, appropriate treatment of Horner syndrome depends on the underlying cause. The goal of treatment is to eradicate the underlying disease process. In many cases, however, no effective treatment is known. Prompt recognition of the syndrome and expedient referral to appropriate specialists are vital.

• #47 Horner Syndrome: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17836-horners-syndrome

  The treatment for Horner syndrome involves treating the underlying cause. As there are many possible causes, the kinds of treatment can vary widely. […] If you have symptoms of Horner syndrome, such as one drooping upper eyelid, mismatched pupil sizes and lack of sweating on the same side of your face, see a healthcare provider as soon as possible. […] Because of this, its crucial to see a healthcare provider if you develop the syndrome so they can determine the underlying cause and treat it immediately.

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