Acquired Horner Syndrome in a Mother and Daughter

A 41-year old right handed white woman woke up with a dull, pressure -like headache in the right orbit. While she was putting on her makeup, she noticed drooping of her right upper eye lid. Her headache did not interfere with her activities of daily living. She thought she was experiencing a “sinus headache”. She does not recall when her headache went away but denies taking any medications for it. She denied any other associated symptoms with this episode.

One week following this episode, the patient experienced the “worst headache of her life” and went to the hospital for further evaluation. Her ophthalmologic and neurologic exams were normal except for a right Horner syndrome.

The patient's evaluation included an MRI/MRA of the brain, a four vessel angiogram, a CT of the chest, and an MRI of the cervical and thoracic spine, all of which were normal. The mother of the patient had also developed a Horner syndrome at a similar age. Familial congenital Horner syndrome has been described in the literature. To our knowledge, this represents the first case report of familial acquired Horner syndrome.     

Isolated Horner syndrome and syrinx of the cervical spinal cord

PURPOSE: To alert ophthalmologists to the possibility of a spinal cord lesion in individuals with Horner syndrome and no neurologic symptoms. DESIGN: Observational case report. METHODS: Neuro-ophthalmic and neuroimaging assessment of a 16-year-old man with an isolated Horner syndrome localizing to a first- or second-order neuron. RESULTS: With magnetic resonance imaging, a syrinx of the cervical spinal cord extending from C5 to C7 was found. No Chiari malformation was present. CONCLUSION: Patients with an isolated Horner syndrome localizing to a first- or second-order sympathetic neuron should undergo magnetic resonance imaging of the head, neck, spinal cord, and chest to investigate for possible origins. An isolated Horner syndrome may be the presenting manifestation of a cervical syrinx.     

首诊于眼科的成人非创伤性霍纳综合征临床特点及病因分析

目的 分析首诊于眼科的成人非外伤性、非医源性霍纳综合征(Horner syndrome,HS)的临床特点及病因.设计回顾性病例系列.研究对象2018年1月至2020年6月首诊于眼科的HS患者7例.方法 回顾患者的临床及影像学资料,分析其临床表现特点,病变位置及病因.主要指标起病形式、HS三主征、其他临床表现及影像学检查...     

Multidetector Computed Tomographic Angiography in Horner Syndrome

A 62-year-old man presented with Horner syndrome secondary to an internal carotid artery dissecting aneurysm detected by multi-detector computed tomographic angiography (MDCTA). Follow-up imaging failed to demonstrate any significant reduction in the size of the aneurysm despite resolution of clinical signs, suggesting that localized inflammation may play an important aetiological role. The size of aneurysm required to cause Horner syndrome has not been fully elucidated, but is important as it determines the likelihood of detection. We report a case in which MDCTA successfully visualized a small, clinically significant dissecting aneurysm causing Horner syndrome.     

Acute Pre-ganglionic Horner Syndrome Positive to Apraclonidine Test

Horner syndrome (HS) is characterized by pupillary miosis, upper eyelid ptosis, apparent enophthalmos and facial anhidrosis. It has been reported as a rare complication of thoracic surgery. We describe a 12-year-old girl who presented with a pre-ganglionic HS one day after cardio-thoracic surgery for post-ductal coarctation of the aorta. Apraclonidine test was positive on the twelfth day following the onset of HS.     

Latanaprost Treatment of the Heterochromia in a Patient with Acquired Horner Syndrome

Horner syndrome results from either congenital or acquired causes of sympathetic denervation. Heterochromia, a clinical feature of congenital Horner syndrome, is quite rare in acquired Horner syndrome, especially after the age of two. There were only a few cases reported previously. We reported a 24-year-old man who was diagnosed up on pharmacological tests and clinical findings as acquired Horner syndrome with heterochromia. The main complaint of the patient was hypochromia on the affected side, which was obviously improved after 19 months of latanoprost treatment.     

Horner Syndrome in a Case of Neuromyelitis Optica

A 58-year-old right-handed woman presented with neck pain and right hemibody decreased pain and temperature sensation. Over the next 3 days, she developed left ptosis and miosis. The Horner syndrome was confirmed with 0.5% apraclonidine and neuromyelitis optica immunoglobulin G antibody titres were positive. Magnetic resonance imaging of the cervical spine showed a longitudinally extensive intramedullary expansile lesion more prominent on the left, with post-contrast enhancement extending from C2 to C5, consistent with neuromyelitis optica. This patient was diagnosed with neuromyelitis optica with an associated left Horner syndrome.     

Inferior tarsal muscle-conjunctivectomy for reverse ptosis repair: A novel technique

We describe a new technique for treatment of reverse ptosis in a patient with Horner Syndrome by means of excision of conjunctiva and inferior tarsal muscle. Surgery with eversion of inferior ptotic eyelid, placement of the Putterman ptosis clamp on the conjunctiva under inferior tarsus, suturing under incarcerated tissue and resection of 6mm of conjunctiva and inferior tarsal muscle was done under local anaesthesia in a short operating time with good cosmetic results without eyelid malposition or skin scar.     

Síndrome de Horner pediátrico. A propósito de una serie de 14 casos en un hospital terciario

BackgroundHorner syndrome (HS) is characterised by the triad of upper eyelid ptosis, miosis, and facial anhidrosis. Due to its wide variety of causes, it can occur at any age, and is uncommon in paediatrics. The aetiology and diagnostic approach of paediatric HS (PHS) is controversial.ObjectiveThe purpose of this study is to describe the clinical characteristics of a 14 case series, focusing on the aetiology of HS and the clinical evolution the patients presented.MethodsA retrospective observational study was conducted on patients under 14 years-old (enrolled between 1 st January 2009 and 30th April 2020). Depending on the age at diagnosis (before or after the first 5 months of life), the study cases were divided into two groups: congenital or acquired.ResultsFourteen patients, with a mean age of 8.5 months, were enrolled. The most frequent cause of PHS were tumours (6/14), with the most representative neoplasm being neuroblastoma (4/14). Of the acquired cases (8/14), the most frequent cause was iatrogenic (5/8), mainly secondary to cervical or thoracic surgery. The main origin of congenital HS (6/14) was neuroblastoma (4/6), being the first manifestation of the disease in 50% of patients (2/4).ConclusionHS may be the first sign of a major underlying disease, such as neuroblastoma. For this reason, children presenting with HS of unknown origin require imaging studies to exclude a life threatening disease. A thorough examination is essential for early diagnosis of these patients.     

Unusual Cause of Horner Syndrome 13 Years After In Situ Ductal Carcinoma

Horner syndrome can be caused by a wide range of pathologies along the sympathetic nerve chain, from the hypothalamus to the orbit. Imaging workup of Horner syndrome is necessary given the potential for deadly lesions, especially in a patient with a previous cancer history. The authors report a case of a woman who presented with a preganglionic Horner syndrome secondary to vertebral metastasis from previously diagnosed breast cancer that involved the neural foramina at T1 and T2.     

Correction of Enophthalmos in the Anophthalmic Orbit

Enophthalmos with an associated superior sulcus syndrome is a common finding in the anophthalmic socket. Two common causes are: (1) progressive relaxation of the lower eyelid leading to downward migration of the prosthesis and associated ectropion formation; and (2) decreased volume of the orbit. Relaxation of the lower eyelid is corrected with repair and support using autogenous fascia lata. Decreased volume of the orbit is corrected with implantation of RTV silicone. The surgical techniques, surgical complications, ocular prosthetic modifications and follow-up on 20 patients are discussed.     

Management of morderate-to-severe Marcus-Gunn syndrome by anastomosis of levator and frontal muscles

AIM: To study the effect of clinical management of moderate-to-severe Marcus-Gunn syndrome (MGS) by anastomosis of levator and frontal muscles. METHODS: The medical records of 13 patients with moderate-to-severe MGS who underwent surgeries in our institute between 2000 and 2007 were reviewed retrospectively. They underwent unilateral anastomosis of levator and frontal muscles under local anesthesia. RESULTS: Postoperative follow-up periods ranged from 6 to 36 months, with an average of 12 months. All eyelids (100%) showed complete resolution of jaw-winking, ten eyelids (76.9%) had good correction of ptosis, with equal plapebral apertures and symmetrical contours, three (23.1%) showed residual mild ptosis (<2mm). CONCLUSION: For moderate-to-severe MGS, unilateral ana- stomosis of levator and frontal muscles provides satisfied correction of jaw-winking and ptosis.     

中重度Marcus-Gunn综合征患者的手术治疗

目的分析中重度Marcus-Gunn综合征患者的临床特点,评价其手术治疗效果。方法收集武汉大学人民医院2006年1月至2010年1月收住院治疗的12例中重度Marcus-Gunn综合征患者的病历资料,对其临床特点进行分析。患者均行患眼提上睑肌离断联合同侧额肌瓣悬吊术治疗颌动瞬目现象,术后随访6个月,依据静态时双眼睑弧度及对称情况、颌动瞬目现象根治情况评价其术后治疗效果。结果所有患者术前下颌运动时上睑至少开大到角膜上缘,男性多于女性(男8例,女4例),均为单眼发病,右眼7例,左眼5例。术前8眼伴随屈光不正,5眼伴有斜视。术后2眼出现角膜点样损害,药物治疗7d后恢复。随访期末进行颌动瞬目矫治效果评价中10眼效果良好,2眼效果满意。结论中重度Marcus-Gunn综合征患者伴有的颌动瞬目现象可通过手术治疗,患侧提上睑肌离断联合同侧额肌肌瓣悬吊术可以满意地矫正Marcus-Gunn综合征患者伴有的中重度颌动瞬目现象。     

小睑裂综合征的联合手术方法

目的探讨小睑裂综合征的联合手术方法。方法小睑裂综合征l3例26眼,采用三联手术,即上睑提肌缩短术、上睑提肌缩短加横韧带悬吊术、额肌腱膜悬吊术或额肌悬吊术治疗上睑下垂;Spaeth双“Z”成形术和“Y-V”成形术治疗内眦赘皮;并进行外眦开大术以扩大睑裂,3项手术一次完成。结果术后外观有明显改善,睑裂长度和高度显著增加,内眦间距显著缩短。术前睑裂长度19~24mm,平均(21.0±1.4)mm,睑裂高度:1~4mm,平均(2.3±1.1)mm,内眦间距35~40mm,平均(37.0±1.6)mm,术后睑裂长度25~30mm,平均(27.4±1.3)mm。睑裂高度:5~8mm,平均(6.2±0.9)mm。内眦间距30~35mm,平均(32.7±1.3)mm,各相应组两两比较差异均有统计学意义(P=0.000)。结论三联手术治疗小睑裂综合征取得良好效果。     

上斜肌肌腱截除术治疗Brown综合征的临床观察

目的探讨上斜肌肌腱截除术治疗Brown综合征的手术效果,为临床治疗提供一定的参考依据。方法 28例先天性Brown综合征患者,采取上斜肌肌腱截除术,比较手术前后眼位、眼球运动、内转时下转现象、牵拉试验及代偿头位。结果术后垂直斜视角度为0△(0△,25△),与术前相比改善幅度为19△(10△,40△),与术前比较差异有统计学意义(z=4.64,P<0·001)。术后12个月斜视角度为0△(0△,20△),与术前相比改善幅度为20.5△(8△,40△),差异也有统计学意义(z=4.64,P<0·001)。术后眼位满意率达到92.86%。术前18例有代偿头位患者术后8例代偿头位消失,8例好转,2例无改善,术后12个月,8例患者代偿头位完全消失,其余10例患者好转。全部患者术后患眼内转时下转现象消失,被动牵拉试验结果阴性,眼外肌运动情况得到不同程度的改善。结论上斜肌肌腱截除术是治疗先天性Brown综合征的一种简单、安全、有效的方法。     

Orbital apex syndrome after tooth extraction in an immunocompromised patient

A 60 year-old man presented with acute on set of left eye proptosis and ptosis. It was associated with poor vision, eye pain and restriction of eye movement of the same eye after 5 hours post left upper molar tooth extraction. The visual acuity in the left eye was hand movement. There was severe ptosis and proptosis of the left eye. The conjunctiva was chemotic with quite anterior chamber. The pupil was mid dilated and sluggished to light. The ocular movement was restricted in all directions. Fundoscopy of the left eye revealed features of central retinal artery occlusion with hyperaemic disc and subretinal exudates at posterior pole. The right eye appeared normal. Urgent MRI brain and orbit revealed severe left paranasal sinusitis with anterior displacement of the left globe and presence orbital abscess. Patient was managed with Otorhinolaryngology and Neurosurgery teams. He underwent emergency transnasal drainage of abscess. Histopathological examination of unhealthy sinus mucosa showed evidence of fungal infection. However, the culture and sensitivity result was inconclusive. Patient was treated with amphotericin B, ceftriaxone, amoxicillin clavulanate and metronidazole. Patient was detected to have high blood sugar level and was managed accordingly. The proptosis improved with treatment. However, his vision, ptosis and ophthalmoplegia remained static. Assessing the immunocompromised status is important for the management of patient presented as acute orbital apex syndrome to avoid fatal outcome.     

Helveston综合征手术治疗的临床分析

目的：探讨Helveston综合征的一次性手术治疗方法。

方法：回顾分析我院眼科收治的7例14 眼Helveston 综合征患者,根据患者上斜肌亢进的程度和斜视程度,实施一次性手术治疗Helveston综合征。

结果：患者7例14眼均行双眼上斜肌鞘内断腱术。其中3例6眼联合双眼外直肌后徙并一眼内直肌缩短术; 4例4眼联合单眼外直肌后徙并内直肌缩短术。术后随访观察6mo,7例14眼术后眼位均正位,外斜A征消失,分离性垂直偏斜消失。儿童患者3例恢复双眼视功能和立体视觉。

结论：Helveston综合征可以实施一次性手术治疗,且尽早手术治疗可帮助双眼视功能的恢复。     

Horner's syndrome associated with contralateral superior oblique paresis

A patient presented with Homer's syndrome together with a contralateral superior oblique paresis. Both conditions had been present for at least 12 years. While the patient had suffered what he considered to be minor head trauma on the sporting field and admitted to several altercations during his life, there was no specific event in his medical history that could account for this presentation.