Materiały źródłowe

• #1 Horner Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/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. It is primarily acquired following damage to the sympathetic nerve supply, but rare cases of congenital forms have been seen. […] 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. […] As previously described, Horner syndrome is a consequence of sympathetic disruption. The symptomology depends on the location of the lesion, and severity depends on the degree of denervation. […] The sympathetic nervous supply is responsible for pupil dilation (mydriasis). When disrupted, parasympathetic supply is uninhibited, and constriction of the pupil (miosis) ensues.

• #1 Horner Syndrome – StatPearls – NCBI Bookshelf

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

  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. Sympathetic fibers have an extensive course and can be interrupted during extracranial, intracranial, or intra-orbital traversal. The sympathetic fibers may be interrupted centrally, between the hypothalamus and the exit point of fibers from the spinal cord (C8 to T2), or the discontinuation could be peripheral, in the cervical sympathetic chain, at the level of superior cervical ganglion, or along the course of the carotid artery. Preganglionic Horner syndrome can be an ominous sign due to its association with pulmonary malignancies. Overall, the causes of Horner syndrome can be divided according to the anatomical location of disruption.

• #1 The Radiology Assistant : Horner syndrome

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

  Horner syndrome is the result of an interruption of the oculosympathetic nerve system which starts in the posterolateral part of the hypothalamus and goes all the way through the brainstem and the spinal cord (level C8-Th2), cervicothoracic sympathetic ganglia and along the internal carotid artery (and some fibers along the external carotid artery, maxillary artery) and cavernous sinus to the eye. […] Interruption of oculosympathetic pathways leads to inactivation of the superior tarsal muscle resulting in ptosis and inactivation of the dilator muscle producing a miosis. […] The Horner syndrome can be explained by the progressive syringohydromyelia at the cervical level with disruption of the first order neurons of the oculosympathetic pathway. […] The postganglionic neuron starts after the synapse of the superior cervical ganglion at the level C2-3 where the sympathetic plexus passes posterior to the carotid space and anterior to the longus colli muscle. The neuron travels along the internal carotid artery and the cavernous sinus along the n VI and n V via the superior orbital fissure to the superior tarsalis muscle, also called Muller’s muscle. […] In these patients the Horner can resolve when the hematoma minimizes, as was the case in this patient after treatment with antiplatelet agents.

• #1 EyeRounds.org: Horner syndrome due to ipsilateral internal carotid artery dissection

  https://webeye.ophth.uiowa.edu/eyeforum/cases/305-Horner_Syndrome.htm

  Horner syndrome is a condition that presents with characteristic clinical signs as a result of damage to the ipsilateral oculosympathetic pathway. The classical triad of Horner syndrome is: (1) ipsilateral upper eyelid ptosis, (2) miosis and (3) facial anhidrosis. The diagnosis is based on clinical signs but may be confirmed with pharmacologic testing. Understanding the anatomical neuronal pathways of the sympathetic innervation to the eye and face is critical to understanding the signs and symptoms of Horner syndrome. […] Sympathetic innervation to the eye is mediated by a three neuronal chain that begins in the hypothalamus. First order neurons arise in the posterolateral hypothalamus and descend through the intermediolateral brain stem before synapsing in the lateral column of the spinal cord at the ciliospinal center of Budge at the level of C8-T1. Infarctions and neoplasms near the hypothalamus or along the pathway of the first order neuron may interrupt the sympathetic supply and cause Horner syndrome. In addition to the classical triad of miosis, ptosis, and anhidrosis, central preganglionic lesions often have additional clinical manifestations due to the close proximity of nearby neurological structures.

• #1 Horner Syndrome – StatPearls – NCBI Bookshelf

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

  As previously described, Horner syndrome is a consequence of sympathetic disruption. The symptomology depends on the location of the lesion, and severity depends on the degree of denervation. The superior tarsal muscle helps raise the upper eyelid and has a sympathetic nerve supply. Denervation of this muscle causes ptosis, which is milder than oculomotor (CN III) palsy, which supplies the levator palpebrae superioris. The sympathetic nervous supply is responsible for pupil dilation (mydriasis). When disrupted, parasympathetic supply is uninhibited, and constriction of the pupil (miosis) ensues. Ipsilateral anhidrosis, another classic presentation, depends on the level of interruption of the sympathetic supply. Anhidrosis with first-order neuron lesions affects the ipsilateral side of the body as the sympathetic supply from its central origin. Iris heterochromia (relevant deficiency of pigment in the iris on the affected side) is seen in children younger than 2 years and is the congenital form of Horner syndrome.

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

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

  As previously described, Horner syndrome is a consequence of sympathetic disruption. The symptomology depends on the location of the lesion, and severity depends on the degree of denervation. The superior tarsal muscle helps raise the upper eyelid and has a sympathetic nerve supply. Denervation of this muscle causes ptosis, which is milder than oculomotor (CN III) palsy, which supplies the levator palpebrae superioris. The superior tarsal muscle is responsible for keeping the upper eyelid in a raised position after the levator palpebrae superioris raises it. This explains the partial ptosis seen in Horner syndrome. The lower eyelid may be slightly elevated owing to the denervation of the lower lid muscle, which is analogous to the superior tarsal muscle. The sympathetic nervous supply is responsible for pupil dilation (mydriasis). When disrupted, parasympathetic supply is uninhibited, and constriction of the pupil (miosis) ensues. The reaction of the pupils to light and accommodation is normal as those systems do not depend on sympathetic nerve supply. Ipsilateral anhidrosis, another classic presentation, depends on the level of interruption of the sympathetic supply. Anhidrosis with first-order neuron lesions affects the ipsilateral side of the body as the sympathetic supply from its central origin. The ipsilateral face is involved in lesions involving the second-order neurons. Postganglionic third-order neuron lesions after the vasomotor and sudomotor fibers have branched off show very limited involvement of the face (area adjacent to the ipsilateral brow). Iris heterochromia (relevant deficiency of pigment in the iris on the affected side) is seen in children younger than 2 years and is the congenital form of Horner syndrome.

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

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

  Lesions in the cavernous sinus that produce a postganglionic Horners syndrome may also produce other ocular motor nerve palsies. […] We know that pupil size is a tug of war battle between the iris dilator muscle (sympathetic innervation) and the iris sphincter muscle (parasympathetic innervation). […] When the sympathetics are damaged, the dilator can no longer perform its job. […] Thus, the parasympathetic sphincter muscle takes over, which creates a miotic pupil on the affected side. […] When the sympathetic innervation to these muscles is damaged, we will see a subtle ptosis (approx. 2mm) of the upper lid and reverse ptosis of the lower lid. […] Management and prognosis of Horners Syndrome depends on the etiology. […] Sometimes the etiologies of Horners are life-threatening. […] Treatment modalities often involve surgery (sometimes emergent), chemotherapy or radiation, or anticoagulants. […] Of particular importance, recognize that the onset of an acute Horners Syndrome with head, neck, or face pain is an emergency.

• #1 Horner’s Syndrome: A Positive Apraclonidine Test—Now What?

  https://www.reviewofoptometry.com/article/horners-syndrome-a-positive-apraclonidine-testnow-what

  Apraclonidine testing can easily confirm the diagnosis of Horners syndrome, but is unable to localize the lesion. Due to the long course of the oculosympathetic pathway from hypothalamus to the eye, there are multiple locations of potential pathology in Horners syndrome. Common etiologies include, but are not limited to: carotid artery dissection, aortic dissection, trauma, demyelinating disease such as multiple sclerosis (MS), tuberculosis, sarcoidosis, cluster headache, Pancoast syndrome, herpes zoster, giant cell arteritis (GCA) and malignancy. A careful physical exam and patient history can help guide imaging studies to aid in determining the location of the lesion. […] Carotid artery dissection, which affects the third-order neuron, can result from relatively minor trauma, or can occur spontaneously in patients with histories of connective tissue disease such as Ehlers-Danlos syndrome, Marfans syndrome or those with long-standing hypertension. In patients with histories of tobacco use, ipsilateral shoulder or arm pain or muscle weakness of the hand and arm, localization could lead to a lesion at the apex of the lung. As the oculosympathetic plexus courses over the apex of the lung via the second-order neuron, multiple pulmonary pathologies can cause Horners syndrome. For instance, Pancoast syndrome is a malignancy of the superior pulmonary sulcus most often caused by non-small cell lung carcinoma. Pancoast tumor has a rapid and high mortality rate.

• #1 Horner Syndrome – EyeWiki

  https://eyewiki.org/Horner_Syndrome

  Horner’s syndrome results from a lesion to the sympathetic pathways that supply the head and neck, including the oculosympathetic fibers. […] The etiology of Horner’s syndrome varies with the patient age and site of lesion. The etiology remains unknown in 35-40% of cases. […] Central (first order neuron) Horner’s: These include lesions of the hypothalamus, brainstem and spinal cord such as stroke (classically the lateral medullary syndrome), demyelination (such as multiple sclerosis), neoplasms (such as glioma), or other processes such as a syrinx (syringomyelia or syringobulbia). […] Preganglionic (second order neuron) Horner’s: These include lesions of the thoracic outlet (cervical rib, subclavian artery aneurysm), mediastinum (mediastinal tumors), pulmonary apex (Pancoast’s tumor), neck (thyroid malignancies) or the thoracic spinal cord (trauma) or surgical procedures in this region including radical neck dissection, jugular vein cannulation, thoracoscopy or mediastinoscopy, chest tube placement and other thoracic surgical procedures.

• #1 Horner Syndrome – EyeWiki

  https://eyewiki.org/Horner_Syndrome

  Third order neuron or postganglionic lesion: These include lesions of the superior cervical ganglion (trauma, radical neck dissection or jugular vein ectasia), lesions of the internal carotid artery (ICA) in the neck and skull base (dissection, thrombosis, invasion by tumors or iatrogenic from endarterectomy or stenting, base of skull malignancies), lesions of ICA in the cavernous sinus (thrombosis, aneurysm, inflammation or invasive tumors) and lesions of the sellar and parasellar regions (invasive pituitary tumors, metastatic tumors, paratrigeminal tumors). Other causes include cluster headaches. […] In children, trauma (birth trauma or neck trauma) is the most common cause of Horner’s syndrome. […] Other causes include surgical trauma, neuroblastoma, brainstem lesions (such as vascular malformations, glioma and demyelination) and carotid artery thrombosis.

• #1 EyeRounds.org: Horner syndrome due to ipsilateral internal carotid artery dissection

  https://webeye.ophth.uiowa.edu/eyeforum/cases/305-Horner_Syndrome.htm

  Internal carotid artery dissection affects the third-order neuron and can classically present with Horner syndrome. An internal carotid artery dissection is due to a spontaneous or trauma-related tear in the intimal layer of the artery which can lead to the formation of an intramural hematoma. This hematoma can bulge inwards towards the lumen of the artery, causing stenosis or the hematoma can expand outwards causing a pseudoaneurysm. When intimal internal carotid artery dissections cause stenosis, there is an increased risk of thrombus formation in the lumen, which can cause a stroke. […] Dissections of the adventia can also cause a Horner syndrome, but there is no associated luminal narrowing. Expanding hematomas or pseudoaneurysms along the internal carotid artery compress postganglionic sympathetic fibers in about half of carotid dissection cases. Lesions to the postganglionic neurons in this region do not affect facial sweating (except in the area of skin above the eyebrow) because the sympathetic supply to the sweat glands ascends along the external carotid plexus.

• #1 Horner syndrome: clinical perspectives | EB

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

  The causes of Horner syndrome in children are usually classified as congenital or acquired. […] Neuroblastoma is the most common occult malignancy associated with Horner syndrome, with an incidence of one in 7,000 children younger than the age of 5 years. […] 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.

• #1 Horner’s Syndrome: Symptoms, Causes, and Treatment | Doctor

  https://patient.info/doctor/horners-syndrome

  This is a rare condition that results from disruption of the sympathetic nerves supplying the eye. […] First-order sympathetic fibres originate in the hypothalamus and descend through the brainstem to level C8-T2 of the spinal cord where they synapse on preganglionic sympathetic nerve fibres. […] Second-order fibres leave the cord at level T1 and ascend in the sympathetic chain over the apex of the lung to synapse in the superior cervical ganglion at the level of the bifurcation of the common carotid artery (C3-C4). […] Third-order (postganglionic) fibres pass alongside the internal carotid artery, sending branches to the blood vessels and sweat glands of the face, and pass via the cavernous sinus to enter the eye via the superior orbital fissure. […] Horner’s syndrome associated with pain always needs investigation. If there is arm, shoulder or hand pain think of Pancoast’s syndrome. If pain is in the face or neck, think of carotid dissection. Pain and transient visual loss may be due to carotid dissection. […] Preganglionic lesions are less common but are more likely to be malignant.

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

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

  Horners syndrome (HS) is a combination of clinical signs, classically of ipsilateral ptosis, pupillary miosis, and facial anhydrosis, secondary to the interruption of the oculosympathetic pathway. […] In the majority of cases, the cause of an isolated HS will be benign or from a previously identified cause, for example, postsurgical. However, it is important to consider carotid dissection or neoplasm as an underlying cause. The long anatomical pathway of the oculosympathetic chain makes it vulnerable to many pathological processes. […] The underlying pathology of the HS will be apparent in over 80% of patients at the time of the first neuro-ophthalmic consultation, based on history or clinical localisation of the lesion. […] A painful HS is the most common ocular sign of internal carotid artery (ICA) dissection, and has been reported in up to 58% of cases of ICA dissection, with only one case report presenting as a painless HS.

• #1 Horner syndrome: clinical perspectives | EB

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

  The postganglionic (third-order) sympathetic neurons originate in the superior cervical ganglion, travel in the wall of the internal carotid artery, and continue on to the cavernous sinus. […] Lesions of the internal carotid artery classically present with unilateral head and/or neck pain, focal cerebral ischemic symptoms, and a Horner syndrome. […] Damage to the superior cervical ganglion can cause a postganglionic Horner syndrome as the ganglion lies about 1.5 cm behind the palatine tonsil and can be damaged by traumatic penetrating intraoral injury or even procedures such as tonsillectomies, intraoral surgery, and peritonsillar injections. […] Cluster headaches are severe lancinating unilateral headaches characterized by ipsilateral tearing, nasal stuffiness, conjunctival injection, and ptosis.

• #1 Horner syndrome | MedLink Neurology

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

  Disorders of the third-order oculosympathetic pathway affect the high cervical neck region (internal carotid dissection, internal jugular venous cannulation, neck, dental, oropharyngeal, and parapharyngeal trauma and infections), middle ear (infections), carotid canal (aneurysms, trauma), and cavernous sinus (aneurysms, neoplasms, inflammations). […] Horner syndrome is the most common and often only sign of carotid dissection, occurring in 38.5% to 44% of patients. […] The mechanism of Horner syndrome in these trigeminal autonomic cephalgias is unknown. Horner syndrome should not, however, be attributed to a trigeminal autonomic cephalgia unless a structural cause has been ruled out.

• #1 Horner’s syndrome – Wikipedia

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

  Horner syndrome is due to a deficiency of sympathetic activity. The site of lesion to the sympathetic outflow is on the ipsilateral side of the symptoms. The following are examples of conditions that cause the clinical appearance of Horner’s syndrome: […] First-order neuron disorder: Central lesions that involve the hypothalamospinal tract (e.g. transection of the cervical spinal cord). […] Second-order neuron disorder: Preganglionic lesions (e.g. compression of the sympathetic chain by a lung tumor) that releases acetylcholine. […] Third-order neuron disorder: Postganglionic lesions at the level of the internal carotid artery (e.g. a tumor in the cavernous sinus or a carotid artery dissection) that releases norepinephrine. […] Partial Horner’s syndrome: In case of a third-neuron disorder, anhidrosis is limited to the middle part of the forehead or can be absent, resulting in a partial Horner’s syndrome.

• #1 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. This muscle inserts into the tarsal plate of the upper eyelid and controls eyelid elevation and retraction. […] 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.

• #1 Horner syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/horner-syndrome/symptoms-causes/syc-20373547

  Horner syndrome is a condition that affects the face and eye on one side of the body. It is caused by the disruption of a nerve pathway from the brain to the head and neck. […] Horner syndrome is caused by damage to a certain pathway in the sympathetic nervous system. The sympathetic nervous system regulates heart rate, pupil size, perspiration, blood pressure and other functions that enable you to respond quickly to changes in your environment. […] The nerve pathway affected by Horner syndrome is divided into three groups of nerve cells (neurons). […] This neuron pathway leads from the hypothalamus at the base of the brain, passes through the brainstem and extends into the upper portion of the spinal cord. […] This neuron path extends from the spinal column, across the upper part of the chest and into the side of the neck. […] This neuron path extends along the side of the neck and leads to facial skin and muscles of the iris and eyelids. […] In some cases, the cause of Horner syndrome cannot be identified. This is known as idiopathic Horner syndrome.

• #1 Horner’s syndrome: Overview, symptoms, and more

  https://www.medicalnewstoday.com/articles/horners-syndrome

  Horners syndrome occurs due to a interruption anywhere along the sympathetic nerve pathway from the brain to the face. […] Interference with the sympathetic nerves that connect the brain and the face causes Horners syndrome. […] In clinical practice, no treatable lesion is identified in the vast majority of Horners syndrome cases. When a cause is identified, it is usually due to a lesion or growth somewhere along the sympathetic nerve pathway between the hypothalamus of the brain and the eye. […] Some researchers believe that Horners syndrome can also have a genetic cause in certain cases. […] Any damage to the three distinct segments of the sympathetic nervous system could lead to Horners syndrome. The sympathetic nerve connects the brain to the face, enabling functions such as pupil dilation and constriction, and sweating. […] An interruption of the sympathetic nerve pathway connecting the brain and the face causes Horners syndrome. Disruption of the sympathetic nerve pathway may occur as a result of injury, infection, or disease. Some cases may have a genetic cause, whereas most are benign and idiopathic.

• #1 Horner syndrome secondary to internal carotid artery dissection after a short-distance endurance run: A case study and review | Journal of Optometry

  https://www.journalofoptometry.org/en-horner-syndrome-secondary-internal-carotid-articulo-S1888429612000556

  The mechanism of action is best understood on a histological level of blood vessel anatomy. Typically, injuries causing an ICAD involve hyperextension and rotation of the neck. The internal carotid artery is stretched as it crosses the processes of the cervical vertebrae. […] A history of hypertension, smoking, and oral contraceptive use have been shown to be more prevalent in ICAD patients, however atherosclerosis is distinctly uncommon in patients with ICAD. […] As previously mentioned, Horner syndrome is the most common ocular finding in individuals with ICAD. […] Timely recognition and referral for urgent imaging studies and anticoagulation medications with the patient’s primary care physician are important for eye care providers in order to help prevent any ischemic insults to the brain and/or ocular tissues that can affect morbidity and/or mortality of patients.

• #1 Horner’s Syndrome – Neuropedia

  https://neuropedia.net/articles/neurology/spinal-cord/horners-syndrome/

  Meanwhile, second-order neuron lesions arise from different causes. Trauma or tumors are the most common causes of preganglionic Horners syndrome. These can result from direct spinal cord damage or tension on the brachial plexus. Surgical trauma and epidural spinal anesthesia are examples of iatrogenic injuries frequently causing damage. Lung and mediastinal malignancies can also affect this neuron, such as in Pancoast syndrome, where a tumor at the apex of the lung causes pain in the arms and shoulders. Therefore, in any patient presenting with new-onset Horners syndrome and shoulder or arm discomfort without a history of trauma, the possibility of undetected cancer should be considered. […] Lastly, the third-order neuron may be affected by pathologies involving the cavernous sinus, skull base, or internal carotid artery. Lesions can result from carotid artery dissection, cavernous sinus pathology, or cluster headaches.

• #1 Isolated Horner’s Syndrome Secondary To Rhinosinusitis: A Case Report And Literature Review | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text

  https://ejnpn.springeropen.com/articles/10.1186/s41983-020-00165-4

  The isolated HS associated with sinusitis of our case probably occurred with the same pathological mechanism as Raeder syndrome already reported in other sinus infections. […] Therefore, we hypothesized that the inflammation caused by sinusitis might have involved only the distal part of the carotid artery bifurcation since facial sweating was not observed in our subject. […] In sum, our report suggests that sinusitis should be listed as a probable cause of isolated Horners syndrome. Moreover, patients presenting with this presentation probably have a good prognosis.

• #1 Horner Syndrome: A Rare Complication of Cervical and Thoracic Herpes Zoster Infection | Actas Dermo-Sifiliográficas

  https://actasdermo.org/es-horner-syndrome-a-rare-complication-articulo-S1578219015001791

  Horner syndrome (miosis, ptosis, enophthalmos, and/or anhidrosis) is a rare complication of cervical and thoracic herpes zoster. […] The most plausible theory for the pathogenesis of Horner syndrome secondary to thoracic herpes zoster is that either the spinal cord or its ventral roots become inflamed owing to viral activation that spreads by contiguity. […] However, in the case of herpes zoster ophthalmicus, other potential mechanisms have been considered, including ischemic neuritis of the third, fourth, or sixth cranial nerves; a mesencephalic lesion caused by axonal spread of the virus; inflammation by contiguity leading to myositis; or even immune-mediated demyelination due to local or remote viral spread. […] Horner syndrome, or oculosympathetic palsy, is characterized by ptosis, miosis, anhidrosis, and/or enophthalmos, and was classically attributed to space-occupying lesions in the vertex of the lung, such as Pancoast tumor.

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

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

  Horner syndrome, also known as oculosympathetic palsy or Bernard-Horner syndrome, is a relatively rare neurological syndrome that affects your eye and the surrounding tissues on one side of your face. […] It occurs due to a disruption of the pathway of the sympathetic nerves that connect your brainstem to your eyes and face. These nerves control involuntary functions, such as sweating (perspiration) and the dilation and constriction of the pupils of your eyes. […] Most often, Horner syndrome happens as a result of blockage or damage to the sympathetic nerves that lead to your eyes. The underlying causes of nerve damage can vary widely, from a middle ear infection to a carotid artery dissection or apical chest tumor. […] Three different nerve pathways may be involved in Horner syndrome. The nerves from your brain dont travel along a direct path to your eyes and face. They travel along three paths, and disruption can occur in any of these pathways. Because of this, there are three types of Horner syndrome with different possible causes.

• #2 EyeRounds.org: Horner syndrome due to ipsilateral internal carotid artery dissection

  https://webeye.ophth.uiowa.edu/eyeforum/cases/305-Horner_Syndrome.htm

  Preganglionic second order neurons originate in the ciliospinal center of Budge, then exit the spinal cord at T1 and pass across the pulmonary apex before synapsing in the superior cervical ganglion located at the level of the bifurcation of the common carotid artery. Neck surgery, trauma, pneumothorax, and neoplasms along the apex of the lung, such as Pancoast tumors, can damage the second order neuron. Preganglionic lesions are often associated with ipsilateral shoulder pain and weakness/numbness in the C8-T1 distribution. […] Postganglionic or third-order neuronal cell bodies originate in the superior cervical ganglion. The sympathetic nerve fibers then travel along the adventitia of the internal carotid artery into the cavernous sinus. In the cavernous sinus, they travel with the abducens nerve before joining the ophthalmic division of the trigeminal nerve. Efferent fibers enter the orbit via the superior orbital fissure and travel along the two long ciliary nerves to the iris dilator, and also supply the Mller smooth muscle in the upper and lower eyelid.

• #2 Horner syndrome. Horner’s syndrome | PPT

  https://www.slideshare.net/slideshow/horner-syndromepptx/252715120

  Horner syndrome results from disruption of the sympathetic nerve supply to the eye. It is characterized by three key signs: ptosis, miosis, and anhidrosis. The syndrome can be classified based on where along the sympathetic pathway the disruption occurs. Testing involves confirming the diagnosis with apraclonidine, which causes reversal of miosis and ptosis in denervated eyes. Investigations depend on classification and may include imaging of the brain, cervical spine, chest, or neck vessels to identify underlying causes. […] In Horners syndrome there is only partial ptosis since control of the upper eyelid is controlled by two sets of nerves: the IIIrd nerve supplies the levator palpebrae superioris and sympathetic fibres supply the Muller muscle. In Horners syndrome, despite the weakness owing to a dysfunctional Muller muscle, the IIIrd nerve is still intact meaning the ptosis is not complete.

• #2 Horner Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/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. It is primarily acquired following damage to the sympathetic nerve supply, but rare cases of congenital forms have been seen. […] 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. […] As previously described, Horner syndrome is a consequence of sympathetic disruption. The symptomology depends on the location of the lesion, and severity depends on the degree of denervation. […] The sympathetic nervous supply is responsible for pupil dilation (mydriasis). When disrupted, parasympathetic supply is uninhibited, and constriction of the pupil (miosis) ensues.

• #2 Miosis in Horner Syndrome: A Focused Exploration of Its Pathophysiology, Diagnosis, and Clinical Significance – DoveMed

  https://www.dovemed.com/health-topics/focused-health-topics/miosis-horner-syndrome-focused-exploration-its-pathophysiology-diagnosis-and-clinical-significance

  Miosis, or pupil constriction, is a key feature of Horner Syndrome, a rare neurological disorder. Horner Syndrome results from a disruption in the sympathetic nerves supplying the eye and is characterized by a classic triad of symptoms: ptosis (drooping of the upper eyelid), anhidrosis (decreased sweating) on the affected side of the face, and miosis. […] Horner Syndrome occurs due to interruption of the sympathetic nerve pathway, which normally causes dilation of the pupil. […] The loss of sympathetic stimulation leads to unopposed parasympathetic activity, resulting in miosis. […] Miosis in Horner Syndrome serves as a crucial diagnostic clue to this complex neurological disorder. Understanding its pathophysiology and clinical presentation is essential for timely diagnosis and management.

• #2 Horner Syndrome – StatPearls – NCBI Bookshelf

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

  Ipsilateral anhidrosis, another classic presentation, depends on the level of interruption of the sympathetic supply. Anhidrosis with first-order neuron lesions affects the ipsilateral side of the body as the sympathetic supply from its central origin. […] Iris heterochromia (relevant deficiency of pigment in the iris on the affected side) is seen in children younger than 2 years and is the congenital form of Horner syndrome.

• #2 Horner syndrome | MedLink Neurology

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

  The cause of Horner syndrome depends on whether the first-order, second-order, or third-order neuron is affected. […] First-order neurons arise in the hypothalamus, descending through the brainstem in an uncertain location until they reach the medulla, where they are identifiable in the dorsolateral region and subject to damage in vertebral artery occlusion which leads to infarction of the dorsolateral medulla (Wallenberg syndrome). […] First-order (central) Horner syndrome rarely occurs in isolation. It may rarely occur with hypothalamic lesions, but never in isolation. […] Lesions of the spinal cord caused by trauma (including surgery), demyelination, stroke, and tumors have been associated with Horner syndrome. […] Second-order (preganglionic) Horner syndrome often results from trauma or surgery to the paraspinal region, chest, and especially inferior jugular vein cannulation.

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

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

  Central causes include hypothalamic, thalamic or brainstem ischemia (e.g. lateral medullary syndrome), hemorrhage, tumor, and demyelination. […] Pre-ganglionic causes include apical lung mass/tumor (Pancoast tumor), cervical rib, cervicothoracic spine trauma, brachial plexus injury, thyroid mass/goiter/tumor, mediastinal mass tumor, common carotid artery pathology, and injury to superior cervical ganglion. […] Post-ganglionic causes include internal carotid artery pathology such as dissection and aneurysm, carotid-cavernous fistula, cavernous sinus thrombophlebitis, cavernous sinus mass, and nasopharyngeal tumor.

• #2 Horner’s Syndrome: Signs, Causes & Treatment – NVISION

  https://www.nvisioncenters.com/conditions/horners-syndrome/

  Damage to the upper part of the chest into the side of the neck can cause second-order Horners syndrome. […] Third-order Horners syndrome can be caused by damage to the side of the neck and into the muscles of the iris and facial skin. […] In about 35 to 40 percent of cases, the cause of Horners syndrome is unknown. This is often called idiopathic Horner syndrome.

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

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

  As previously described, Horner syndrome is a consequence of sympathetic disruption. The symptomology depends on the location of the lesion, and severity depends on the degree of denervation. The superior tarsal muscle helps raise the upper eyelid and has a sympathetic nerve supply. Denervation of this muscle causes ptosis, which is milder than oculomotor (CN III) palsy, which supplies the levator palpebrae superioris. The superior tarsal muscle is responsible for keeping the upper eyelid in a raised position after the levator palpebrae superioris raises it. This explains the partial ptosis seen in Horner syndrome. The lower eyelid may be slightly elevated owing to the denervation of the lower lid muscle, which is analogous to the superior tarsal muscle. The sympathetic nervous supply is responsible for pupil dilation (mydriasis). When disrupted, parasympathetic supply is uninhibited, and constriction of the pupil (miosis) ensues. The reaction of the pupils to light and accommodation is normal as those systems do not depend on sympathetic nerve supply. Ipsilateral anhidrosis, another classic presentation, depends on the level of interruption of the sympathetic supply. Anhidrosis with first-order neuron lesions affects the ipsilateral side of the body as the sympathetic supply from its central origin. The ipsilateral face is involved in lesions involving the second-order neurons. Postganglionic third-order neuron lesions after the vasomotor and sudomotor fibers have branched off show very limited involvement of the face (area adjacent to the ipsilateral brow). Iris heterochromia (relevant deficiency of pigment in the iris on the affected side) is seen in children younger than 2 years and is the congenital form of Horner syndrome.

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