On the shoulders of giants: the case of the Claude Bernard Horner syndrome

The syndrome called mainly in the French world as Claude Bernard Horner was frst described by Francois Pourfour du Petit, in 1727, but more thoroughly defned by the French physiologist, Claude Bernard, in 1852, followed by several physicians who offered different interpretations, mainly Silas Weir Mitchell (1864). The clinical and pharmacological implications, with the fnal wrap-up of the syndrome, were presented by a Swiss ophthalmologist, Johann Friedrich Horner, in 1869. This is a cooperative defnition of a syndrome of the sympathetic disruption of the ocular inervation, with fnal addings mainly about pharmacological approach by Horner, but with credits to many others clinicians and physiologists. This is the case of repeated presentations of a "new sign" in neurology with few additions from one to another.

A síndrome chamada principalmente no mundo francês como Claude Bernard Horner foi descrita pela primeira vez por François Pourfour du Petit, em 1727, mas mais profundamente defnida pelo fsiologista francês, Claude Bernard, em 1852, seguido por vários médicos que ofereceram interpretações diferentes, principalmente Silas Weir Mitchell (1864). As implicações clínicas e farmacológicas, com o desfecho fnal da síndrome, foram apresentadas por um oftalmologista suíço, Johann Friedrich Horner, em 1869. Esta é uma defnição cooperativa de uma síndrome da ruptura da inervação simpática ocular, com adições fnais principalmente sobre a abordagem farmacológica por Horner, mas com créditos para muitos outros médicos e fsiologistas. É o caso de repetidas apresentações de um "novo sinal" na neurologia, com poucas adições de um para o outro.

Síndrome de Horner como presentación de tuberculosis pulmonar / Horner's syndrome as presentation of pulmonary tuberculosis

El síndrome de Horner es el resultado de un bloqueo de la inervación simpática del ojo en cualquier punto de su trayectoria. Puede tener variadas etiologías, y es una forma muy inusual de presentación de tuberculosis pulmonar. Se describe el caso de un paciente que presenta un síndrome de Horner secundario a afectación del ápex pulmonar por tuberculosis.

Horner´s syndrome results from a blockage of the sympathetic innervation to the eye at any point along its trajectory. It presents various etiologies, and it is a very unusual form of presentation of pulmonary tuberculosis. We describe the case of a patient with a Horner syndrome secondary to involvement of the pulmonary apex due to tuberculosis.

Horner's syndrome and paresthesia in the trigeminal nerve territory secondary to epidural analgesia for labor / Síndrome de Horner e parestesia do território do nervo trigêmeo secundário a analgesia peridural para trabalho de parto

Abstract Currently, epidural analgesia is a common procedure for labor analgesia. Although it is considered a safe technique, it is not without complications. Horner's syndrome and paresthesia within the trigeminal nerve distribution are rare complications of epidural analgesia. We report a case of a pregnant woman who developed Horner's syndrome and paresthesia within the distribution of the trigeminal nerve following epidural analgesia for the relief of labor pain.

Resumo A analgesia peridural é hoje em dia um procedimento comum para analgesia do trabalho de parto. Embora seja considerada uma técnica segura, não está isenta de complicações. A síndrome de Horner e a parestesia do território do nervo trigêmeo são complicações raras da analgesia peridural. Relatamos um caso de uma grávida que desenvolveu a síndrome de Horner e parestesia do território do nervo trigêmeo após analgesia peridural para o alívio da dor do trabalho de parto.

Síndrome de Villaret y adenocarcinoma de pulmón: una asociación infrecuente / Villaret syndrome and lung adenocarcinoma: an unusual association

El síndrome de Villaret se define por la afección de los nervios craneales glosofaríngeo (IX), vago (X), espinal (XI) e hipogloso mayor (XII), en conjunción con el síndrome de Horner homolateral a la lesión. Se produce por compresión de estos nervios y de las fibras vecinas del plexo simpático pericarotídeo en la base del cráneo, en particular, en el espacio retroparotídeo. Si bien es un hecho conocido la invasión del sistema nervioso central en el cáncer de pulmón avanzado, esta particular asociación sintomática es extremadamente infrecuente. Presentamos una paciente con diagnóstico reciente de adenocarcinoma de pulmón que desarrolló, en forma simultánea, este síndrome.

Villaret syndrome is defined by the affection of the glossopharyngeal (IX), vagal (X), accessory (XI) and hypoglossal (XII) cranial nerves associated with ipsilateral Horner syndrome. It is caused by the compression of these nerves and the neighboring sympathetic plexus fibers at the base of the skull, particularly in the retroparotid space. Even though the invasion of the central nervous system in patients with advanced lung cancer is a frequent and well known occurrence, this particular symptomatic association is extremely rare. We are reporting the case of a newly diagnosed lung adenocarcinoma patient who is simultaneously developing this syndrome.

Cervical Disc Herniation and Central Horner Syndrome

Central Horner syndrome is a rare condition, comprising a unique pathophysiological phenomenon. It results from vascular lesions, head or thoracic trauma. We describe a case of Horner syndrome associated to cervical disc herniation, and first-order neuron compression. To our knowledge, this is the second case reported to date in the literature.

A síndrome de Horner central é uma condição rara, que compreende um fenómeno fisiopatológico singular. Resulta de lesões vasculares, trauma cerebral ou torácico. Descrevemos um caso de síndrome de Horner associado a hérnia de disco cervical, com lesão de primeiro neurónio. De acordo com a revisão, é o segundo caso reportado na literatura.

A síndrome de Villaret e o espaço retroparotídeo / Villaret syndrome and retroparotid space

A partir do relato de um caso sobre a síndrome de Villaret, o autor ressalta a importância da relação anátomo-clínica, aspectos clínicos e etiologias das síndromes que cursam com o comprometimento dos quatro últimos nervos cranianos quando da sua passagem extracranial.

From the case study of a patient with the Villaret syndrome the author emphasizes the importance of the anatomical-clinical relationship, clinical aspects, and etiologies of syndromes that are associated with the impairment of the last four cranial nerves during its out of skull passage.

Síndrome de Horner congénito: reporte de un caso / Congenital Horner syndrome: a case report

El Síndrome de Horner se refiere a una constelación de signos, los cuales resultan por la interrupción de inervación simpática del ojo y sus anexos. La etiología del mismo varía según la edad del paciente, y puede incluir condiciones que amenazan la vida. En el primer trabajo se presenta para su análisis y discusión el caso de una paciente en edad pediátrica con diagnóstico de síndrome de Horner congénito...

Unusual case of persistent Horner's syndrome following epidural anaesthesia and caesarean section.

This is a rare case of persistent Horner's syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) of head, neck, and chest were unremarkable. Medline search using terms Horner’s, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles describing Horner's syndrome in obstetric epidural anesthesia, of which 11 were following Caesarean section. The increased incidence of Horner's syndrome in the setting of epidural anesthesia in pregnancy may be related to epidural venous engorgement and cephalic spread of the local anaesthetic, with disruption in the oculosympathetic pathway. It is important to include recent epidural anesthesia within the differential diagnosis of acute Horner's syndrome in a postpartum female. Rarely, the ptosis may be permanent and require surgical intervention.

Ganglioneuroma cervical: reporte de un caso / Cervical ganglioneuroma: a case report

Se presenta el caso clínico de un paciente, sexo femenino, 52 años de edad, que al examen clínico presentaba un aumento de volumen a nivel del ángulo mandibular derecho. Los estudios imagenológicos mostraron una extensa masa cervical paravertebral, encapsulada, de límites netos, sin evidencias de calcificaciones en el cuerpo de la lesión como tampoco compromiso del tejido óseo vecino, que se extiende desde la base de cráneo hasta la región de la cara interna del ángulo mandibular derecho. Se determinó la cirugía, como tratamiento, la cual presentó como complicaciones post operatorias, trastornos en la deglución y síndrome de Horner. Por último la biopsia post operatoria arrojó ganglioneuroma y linfonodos sin lesiones histológicas.

A case report of a patient, female, 52 years old, clinical examination showed a volume increase at the right mandibular angle. Imaging studies showed a large cervical paravertebral mass, encapsulated, net limits without evidence of calcification in the body of the lesion nor involvement of neighboring bone tissue, extending from the base of the skull to the region of the inner right mandibular angle. Surgery was determined as treatment, presenting, impaired swallowing and Horner syndrome as post-operative complications. Finally, the postoperative biopsy showed, ganglioneuroma and lymph nodes without histological lesions.

Schwannoma of the cervical symphathetic chain first case report from Oman

Schwannomas are benign, encapsulated and slow-growing nerve sheath tumours arising from Schwann cells. The schwannoma arising from the cervical sympathetic chain [SCSC] is a very rare tumour. It usually presents as a slow growing, painless and asymptomatic neck mass, hence preoperative clinical diagnosis is difficult. Radiological investigation and fine needle aspiration cytology make only a small contribution to its preoperative diagnosis, histopathological examination being much more useful. We report here the first case report of SCSC from Oman. It occurred in a 45 year-old female and was successfully excised

Horner's Syndrome with Abducens Nerve Palsy

A 68-year-old male patient presented with a week of sudden diplopia. He had been diagnosed with nasopharyngeal cancer 8 months prior and had undergone chemotherapy with radiotherapy. Eight-prism diopter right esotropia in the primary position and a remarkable limitation in abduction in his right eye were observed. Other pupillary disorders and lid drooping were not found. After three weeks, the marginal reflex distance 1 was 3 mm in the right eye and 5 mm in the left eye. The pupil diameter was 2.5 mm in the right eye, and 3 mm in the left eye under room illumination. Under darkened conditions, the pupil diameter was 3.5 mm in the right eye, and 5 mm in the left eye. After topical application of 0.5% apraclonidine, improvement in the right ptosis and reversal pupillary dilatation were observed. On brain magnetic resonance imaging, enhanced lesions on the right cavernous sinus, both sphenoidal sinuses, and skull base suggested the invasion of nasopharyngeal cancer. Lesions on the cavernous sinus need to be considered in cases of abducens nerve palsy and ipsilateral Horner's syndrome.

Horner's syndrome after blunt cervical and chest trauma: case report

Horner‘s syndrome is the triad of miosis, ptosis, and anhidrosis, resulting from disruption of the sympathetic pathways. This article describes an uncommon case of Horner‘s syndrome in a 22-year-old man after blunt trauma to the neck and chest without carotid artery dissection. The patient was brought to the emergency service after motorcycle fall. Neurologic examination revealed a patient presenting the score 15 at Glasgow Coma Scale. The left eyelid was 1-2 mm lower than the right. Carotid Doppler and angiotomography were undertaken and revealed no abnormalities of the carotid artery. CT disclosed a mediastinal hematoma extending to the left apex, compressing the left sympathetic chain. The understanding of this clinical entity may help the surgeon to make a better differential diagnosis in trauma patients in whom prompt diagnosis is critical to stablish the correct treatment.

A síndrome de Horner compreende a tríade de miose, ptose e anidrose, resultado de lesão em algum ponto das vias simpáticas. O referido estudo apresenta um caso da referida síndrome em um jovem de 22 anos vitima de queda de moto, com escoriações no tórax e no pescoço, sem dissecção carotídea. Ao exame neurológico, encontrava-se com 15 pontos na Escala de Coma de Glasgow, com miose à esquerda e ptose palpebral ipsilateral. Realizado Doppler de carótidas e angiotomografia dos vasos cérvico-cranianos não sendo evidenciadas anormalidades. A tomografia de tórax mostrou um hematoma no ápice pulmonar esquerdo, comprimindo a cadeia simpática ipsilateral. O conhecimento desta entidade clínica pode ajudar o cirurgião a fazer um diagnóstico diferencial adequado nos pacientes vítimas de traumas, nos quais o diagnóstico correto e eficaz pode ser fundamental para a definição da conduta a ser tomada.

Unusual complications of empyema thoracis: diaphragmatic palsy and Horner's syndrome.

We report here a 3 month old child with empyema thoracis, who developed complications of diaphragmatic palsy and Horner's syndrome. These complications of empyema thoracis have not been reported earlier. We discuss the possible mechanisms for these complications.

Síndrome de Claude Bernard-Horner associada ao empiema pleural / Claude Bernard-Horner syndrome resulting from pleural empyema

A síndrome de Claude Bernard-Horner apresenta várias etiologias, ocorre por interrupção do estímulo nervoso em qualquer ponto do trajeto do nervo e pode ser intra ou extratorácica. É relatado um caso dessa síndrome causado por empiema pleural septado, localizado em região paravertebral, no terço superior do hemitórax direito. O paciente foi submetido à toracotomia para drenagem da cavidade pleural. A evolução foi satisfatória, com regressão do quadro infeccioso, expansão pulmonar e remissão da síndrome.

Síndrome de Horner pediátrico: análisis de 5 casos / Horner Syndrome: 5 case reports

Introducción: El síndrome de Horner (SH) u oculosimpaticoparesia es causado por la interrupción de la vía simpática (VS) que va desde el cerebro hasta el ojo. Los signos clínicos son miosis, ptosis, enoftalmos, heterocromía del iris y hemianhidrosis facial ipsilateral, en su forma completa. Generalmente es benigno pero la proximidad arterias carotídeas, órganos torácicos y cerebro nos obliga a descartar patologías potencialmente riesgosas. Objetivo: Describir la utilidad de la historia clínica y el examen neurológico en la evaluación de la etiología y localización de la lesión en el SH. Pacientes y Método: 5 pacientes de sexo masculino entre 2-72 meses edad controlados en Neurología infantil de la Pontificia Universidad Católica de Chile entre los años 2003-2004. Resultados: Según tiempo de aparición, 4 casos fueron congénitos y 1 caso adquirido. Los signos neurológicos acompañantes clasificaban los casos como SH periférico (4) y SH central (1). La hemianhidrosis clasificaban 3 casos como preganglionares y dos postganglionares Conclusión: En niños con SH la anamnesis, el análisis de la signología propia y asociada del SH nos ayudan a localizar la lesión y reducen una extensa evaluación sistémica.

Síndrome de Horner após cirurgia estereotaxica para doença de Parkinson / Horner syndrome after stereotactic Parkinson's surgery

Apresentamos estudo de dez pacientes com doença de Parkison, que foram submetidos a procedimentos ablativos estereotaxicos percutaneos e que desenvolveram síndrome de Horner ipsilateral imediatamente após a lesão. Sete pacientes foram submetidos a palidotomia, dois a subtalamotomia (campotomia de Forel) e talamotomia e um paciente a subtalamotomia. Sete desenvolveram miose e os dez desenvolveram semiptose ipsilateral a lesão. A ocorrência da síndrome de Horner resulta possivelmente de lesão de fibras simpaticas entre o hipotalamo, campo de Forel e tálamo

Neurological manifestations of snake bite in Sri Lanka.

BACKGROUND AND AIMS: Snake bite is an important cause of mortality and morbidity in certain parts of Sri Lanka. This study was designed to determine the offending snakes, neurological manifestations, disease course, and outcome in neurotoxic envenomation. METHODS AND MATERIAL: Fifty six consecutive patients admitted with neurological manifestations following snake bite were studied prospectively. Data were obtained regarding the offending snakes, neurological symptoms, time taken for onset of symptoms, neurological signs, and time taken for recovery. RESULTS: The offending snake was Russell's viper in 27(48.2%), common and Sri Lankan krait in 19(33.9%), cobra in 3(5.4%), and unidentified in 7(12.5%). Ptosis was the commonest neurological manifestation seen in 48(85.7%) followed by ophthalmoplegia (75%), limb weakness (26.8%), respiratory failure (17.9%), palatal weakness (10.7%), neck muscle weakness (7.1%), and delayed sensory neuropathy (1.8%). Neurological symptoms were experienced usually within 6 hours after the bite. Following administration of antivenom, the signs of recovery became evident within a few hours to several days. The duration for complete recovery ranged from four hours to two weeks. CONCLUSIONS: Complete recovery of neuromuscular weakness was observed in all patients except for one who died with intracerebral haemorrhage shortly after admission.

Síndrome de Horner após intervenção cirúrgica para exérese de neuroblastoma cervivo-torácico / Horner's syndrome after surgical intervention for excision the cervical thoracic neuroblastoma

Objetivo: Relatar a ocorrência de síndrome de Horner após intervenção cirúrgica para exérese de neuroblastoma cervico-torácico. Local: Fundação Altino Ventura - Recife - PE - Brasil. Método: Relato de Caso. Conclusão: Salienta-se que neste caso a criança já tinha o diagnóstico anterior do neuroblastoma, mas a síndrome de Horner pode ser o primeiro sinal da doença. A ptose palpebral se deve a uma paresia do músculo tarsal de Muller, sendo portanto discreta. Como o eixo visual é livre e a acuidade visual preservada é necessário uma inspeção e biomicroscopia rigorosas na presença de ptose a fim de evitar que a síndrome de Horner passe desapercebida.

Primary mediastinal hydatid cyst.

An unusual case of primary mediastinal echinococcosis in a young female presented with non-specific symptoms. On examination, she had signs of Horner's syndrome and mild superior vena cava compression. She was operated successfully. The final diagnosis could only be made on the operating table and confirmed by histopathology. Hydatid cyst in mediastinum is uncommon but because of surrounding vital structures and potential of its complete cure should be explored without delay.

Aspectos clínicos del síndrome de Horner / Clinical aspects of the Horner's syndrome

En el Instituto de Neurocirugía Asenjo, se estudian 38 casos de Síndrome de Horner para establecer, a partir de la experiencia, pautas que contribuyan al estudio y manejo de estos pacientes. Considerando el examen clínico y las neuroimágenes (TAC cerebral y/o angiografía) se logra determinar con certeza cuál de las tres neuronas de la vía simpática está comprometida en el 90 por ciento de los casos