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Horner's (Bernard-Horner's) syndrome

Etiology: 1) apical lung neoplasm - lung carcinoma (non small-cell carcinoma) - onset may be gradual 2) internal carotid artery dissection [3,5] (generally acute onset) - internal carotid artery aneurysm - internal carotid artery trauma 3) hypothalamic lesion 4) brainstem lesion (see Clinical manifestations below) 5) superior cervical ganglion injury Epidemiology: - can occur in 40 year old woman [2] Pathology: - Horner's syndrome occurs secondary to a lesion in the cervical sympathetic chain - disruption of the sympathetic pathways to the eye - often in association with a Pancoast tumor involving both upper & lower brachial plexus, or its central pathways Clinical manifestations: 1) ipsilateral ptosis, miosis, & anhidrosis (on the side of the sympathetic palsy) 2) enophthalmos may be apparent 3) the affected pupil is slow to dilate (anisocoria) in dim light 4) headache [4] 5) contralateral upper extremity & facial weakness (carotid artery dissection) [5] 6) shoulder pain, shoulder & arm weakness (brachial plexopathy)* 7) dysphagia, nausea & vomiting, hoarseness loss of temperature sensation, pain, & dysmetria suggest brainstem lesion * Pancoast syndrome Radiology: - magnetic resonance angiography needed to rule-out carotid artery dissection [4] Differential diagnosis: - Bell's palsy - no ptosis or miosis

Related

Pancoast tumor (superior pulmonary sulcus tumor)

General

syndrome

References

  1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998
  3. Medical Knowledge Self Assessment Program (MKSAP) 14, 16. American College of Physicians, Philadelphia 2006, 2009 - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  4. Al-khersan H, Rong AJ Acute Ptosis in a Middle-aged Man With Hypertension. JAMA Ophthalmology Clinical Challenge. 2020. Sept 1 PMID: 32672796 https://edhub.ama-assn.org/jn-learning/module/2768201
  5. NEJM Knowledge+
  6. Martin TJ. Horner syndrome: a clinical review. ACS Chem Neurosci. 2018;9:177-186. PMID: 29260849