Horner syndrome due to right subclavian artery dissection: Case report.

This is a novel case of spontaneous subclavian artery dissection presenting with an asymptomatic right Horner Syndrome, highlighting both the importance of carefully evaluating the pupils on comprehensive exam, and also the subclavian arteries when assessing for the cause of Horner Syndrome. This original case serves as a caution for practitioners not to overlook the subclavian arteries in the search for the cause of Horner Syndrome. While rare, spontaneous subclavian artery dissection can occur, and carries a risk of morbidity and mortality that must be mitigated. We present a case of asymptomatic, atraumatic right Horner Syndrome where a spontaneous right subclavian artery dissection was found to be the source. It was managed with aspirin therapy and the patient has not suffered any subsequent cardiovascular events related to the dissection. Careful angiographic evaluation of the subclavian arteries should be included in the workup for Horner Syndrome to assess for subclavian artery dissection.

Establishment of stellate ganglion block in mice.

BACKGROUND: There have been no reports on the successful implementation of stellate ganglion block (SGB) in mice. OBJECTIVES: This study aims to investigate a new method for implementing SGB in mice by placing them in a supine position with abducted upper limbs and touching the trachea and sternoclavicular joint with the hand. METHODS: Fifty BABL/C mice, 8-10 weeks, were selected and randomly divided into four groups: control group (n = 5); SGB-R group (n = 15); SGB-L group (n = 15); and SGB-L + R (group n = 15). SGB was administered with 0.15% ropivacaine solution in a volume of 0.1 mL. The control group received equal volumes of saline. Horner's syndrome, heart rate, and complications such as brachial plexus block, vascular injury, pneumothorax, local anesthetic toxicity, and death were observed. RESULTS: Horner's syndrome developed in 100% of SGB surviving mice; no difference was seen in the time to onset (100.4 ± 13.4 vs 96.7 ± 12.4, mean ± SD, seconds) and duration (264.1 ± 40.5 vs 296.3 ± 48.0, mean ± SD, min) of Horner's syndrome in the left and right SGB (P > 0.05). Compared with the control group (722 [708-726], median [IQR], bpm), the heart rate was significantly slowed down in the right SGB (475 [451.5-491], median [IQR], bpm) (P < 0.05). While the heart rate was slowed down after performing the left SGB, the difference was not statistically significant (P > 0.05). The overall complication rate was 18.4%, with a brachial plexus block rate of 12.3%, a vascular injury rate of 4.6%, and a mortality rate of 1.5%, as well as no local anesthetic toxicity (includes bilateral implementation of SGB) or pneumothorax manifestations were found. CONCLUSIONS: This method allows for the successful implementation of SGB in a mouse model.

Transient Horner's Syndrome: An Unusual Complication of Pneumothorax Treatment.

Horner's syndrome is a rare condition that results when there is an interruption of the sympathetic fibers that run from the stellate ganglion to the eye. The classic triad of Horner's syndrome includes unilateral ptosis, miosis, and anhidrosis. Spontaneous pneumothorax is a rare condition that occurs when there is a sudden collapsed lung without any direct cause. A few cases have been reported of spontaneous pneumothorax associated with iatrogenic Horner's syndrome. A chest thoracostomy is a procedure that can lead to iatrogenic Horner's syndrome. Here, we present the case of a 25-year-old male with a left-sided spontaneous pneumothorax complicated by iatrogenic Horner's syndrome secondary to chest thoracostomy.

Using AI Text-to-Image Generation to Create Novel Illustrations for Medical Education: Current Limitations as Illustrated by Hypothyroidism and Horner Syndrome.

Our research letter investigates the potential, as well as the current limitations, of widely available text-to-image tools in generating images for medical education. We focused on illustrations of important physical signs in the face (for which confidentiality issues in conventional patient photograph use may be a particular concern) that medics should know about, and we used facial images of hypothyroidism and Horner syndrome as examples.

Internal Carotid Artery Dissection Presenting with Transient or Subclinical Horner Syndrome.

Introduction: The most frequently encountered symptoms in internal carotid artery dissection (ICAD) are head or neck pain and cerebral ischemia. Ocular symptoms or signs have been reported as the presenting feature in up to 50% of patients, with (painful) Horner syndrome being the most frequently associated. Horner syndrome is part of the classic triad that depicts the characteristic presentation of ICAD and that consists of pain in the ipsilateral neck, head and orbital regions, (partial) Horner syndrome, and cerebral or retinal ischemia. All patients presenting with painful Horner syndrome should therefore require prompt investigations to rule out carotid artery dissection. In patients with confirmed diagnosis, treatment should be started early to prevent permanent ocular or cerebral complications. Case Presentation: Case 1: A 61-year-old woman presented with right temporal headache, an episode of transient visual loss and drooping of the right upper eyelid. Examination revealed anisocoria, which was more important in darkness. Reversal of anisocoria was observed after instilling drops of apraclonidine 0.5%. Neuroimaging demonstrated intrapetrous ICAD. Headaches, eyelid ptosis, and anisocoria all had resolved the next day. Apraclonidine pharmacologic testing a few weeks later was no longer dilating the previously smaller pupil. Case 2: A 48-year-old man presented with drooping of the right upper eyelid and right occipital headache and facial pain that all started one day after an intense yoga workout. Anisocoria was noticed upon examination, with topical cocaine 10% pharmacologic testing confirming a right Horner syndrome. Neuroimaging revealed ICAD. The patient reported resolution of his eyelid ptosis a few days later. Eyelid ptosis and anisocoria had indeed resolved at a follow-up examination a few weeks later. However, cocaine drop testing still produced anisocoria, compatible with subclinical Horner syndrome. Conclusion: Transient or subclinical Horner syndrome can be the presenting feature in ICAD; in such cases, the characteristic eyelid ptosis and anisocoria may be short-lived and resolve in only a few days. If suspected by clinical history, pharmacologic testing may be helpful in identifying subclinical cases.

Horner's Syndrome Following Dural Puncture Epidural Analgesia for Labor.

Horner's syndrome has been identified as an adverse outcome associated with the administration of epidural analgesia during labor. This syndrome is attributed to the upward spread of the local anesthetic, which may extend toward the superior cervical sympathetic chain. This process could disrupt the sympathetic pathways supplying the facial and ocular areas. We describe a case of a 26-year-old primigravid female with transient isolated Horner's syndrome following dural puncture epidural analgesia during labor.

Horner's Syndrome Following Thyroid Surgery.

Horner's syndrome (HS) is a rare complication of thyroidectomy caused by damage to the oculosympathetic nerves. This article reports the case of a 29-year-old woman referred to the clinic with a newly diagnosed papillary thyroid carcinoma (PTC). Ultrasound studies were concerning for multiple thyroid nodules and an enlarged lymph node, confirmed by a computed tomography (CT) scan. Cytology results of fine needle aspiration (FNA) diagnostic for PTC showed tumors in the thyroid tissue and lymph node. The patient underwent a thyroidectomy and woke up with right-sided ptosis and miosis. Clinical follow-up revealed subjective ipsilateral anhidrosis. She also developed a low parathyroid hormone level and dysphonia, albeit they resolved after months. The patient still exhibits HS eight months after surgery. This paper reviews the literature and attempts to establish the most probable causal factor while providing implications for surgical teams to minimize HS occurrence in future thyroid surgeries.

Diagnosis and treatment of HS after endoscopic thyroid surgery: case report and brief literature review.

Background: Horner's syndrome (HS) is a rare condition due to damage to the 3-neuron sympathetic pathway anywhere between the posterior-lateral nuclei of the hypothalamus and the oculosympathetic fiber, particularly as a post-thyroidectomy symptom. In this case report, we present a case of HS following endoscopic thyroid surgery (ETS) and briefly review the literature. Case report: During a routine physical examination, a 29-year-old female patient was incidentally found to have multiple nodules in the right thyroid. She was subsequently admitted to the Department of General Surgery for further examinations and treatment. A fine-needle aspiration biopsy confirmed malignancy in these nodules. As a result, the patient underwent radical resection of the right thyroid and ipsilateral central lymph node dissection using endoscopy. Pathological diagnosis revealed papillary thyroid carcinoma. Unexpectedly, on the third day after the operation, the patient was diagnosed with Horner's syndrome based on the presence of miosis and ptosis. After 1 week of follow-up, the symptoms related to HS significantly improved. Conclusion: Horner's syndrome is an uncommon complication of thyroidectomy in patients undergoing ETS. Therefore, it is crucial to perform careful operations and minimize iatrogenic surgical damage to reduce the incidence of HS. This case serves as a reminder that making rational judgments and implementing appropriate measures are essential for achieving a favorable prognosis and preserving facial esthetics.

Segmental Zoster Paresis Accompanied by Horner's Syndrome.

We herein report a 90-year-old immunocompromised woman who developed right upper limb weakness and right ptosis with a miotic pupil 1 week after oral therapy for zoster on the right T2 dermatome. The right pupil was dilated with instillation of 1% apraclonidine, indicating Horner's syndrome. The patient was treated with intravenous acyclovir and methylprednisolone. Focal weakness related to zoster, generally known as segmental zoster paresis, improved over five months, but Horner's syndrome remained. We suggest that aggressive intravenous treatment should be considered for rare cases of zoster that occur with a combination of these two neurological conditions.

Static anisocoria in cats and dogs with naturally occurring tick paralysis (Ixodes holocyclus).

OBJECTIVE: To characterise the novel occurrence and neuro-ophthalmological features of static anisocoria in cats and dogs with tick paralysis (TP) (Ixodes holocyclus) due to a single tick located remote from the head and neck. DESIGN: Observational case series with retrospective analysis. METHODS: Medical records were reviewed from 69 cats and 169 dogs treated for TP from a suburban veterinary hospital in Newcastle, New South Whales, between September 2005 and October 2021. RESULTS: Anisocoria was observed in 2/18 (11.1%) cats and 3/30 (10.0%) dogs with a single tick located remote from the head and neck. These proportions were not different when compared within species to 4 of 28 (14.3%) cats and 16 of 98 (16.3%) dogs with aniscocoria with a single tick located on the head and neck region (P = 1 and 0.56 respectively). Anisocoria arose from pupillary efferent dysfunction and included unilateral oculoparasympathetic dysfunction (internal ophthalmoplegia) in one dog, unilateral oculosympathetic dysfunction (Horner's syndrome) in one cat and one dog, and a combination of bilateral, but asymmetric, oculosympathetic and oculoparasympathetic dysfunction in one cat and one dog. CONCLUSION: It is proposed that anisocoria in cases of TP with a tick located remote from the head and neck is due to an intrinsic latent asymmetry in the safety factor for pupillary efferent function that is unmasked by a systemically distributed holocyclotoxin inhibiting neural transmission within this system, and this is the prevailing pathomechanism, rather than a direct local effect, underscoring anisocoria with a tick located on the head or neck.

Multifocal neuropathy and Horner's syndrome due to disseminated pyomyositis in an intravenous drug user.

BACKGROUND: The formation of abscesses with necrosis within large, striated muscles leads to pyomyositis, a condition relatively rarely encountered outside the tropics. Intravenous drug users and other immunocompromised individuals are predisposed toward this infection, which may occur due to local or haematogenous spread of infection to skeletal muscles previously damaged by trauma, exercise, or rhabdomyolysis. METHODS: We report a young male intravenous drug user with rhabdomyolysis due to use of a synthetic opioid, in whom disseminated pyomyositis was detected following evaluation for sciatic and radial neuropathies and Horner's syndrome and review available reports of peripheral nerve dysfunction in the setting of this uncommon infection. We searched online databases to identify all published reports on adult patients with pyomyositis complicated by peripheral nerve dysfunction. CONCLUSIONS: Peripheral nerve dysfunction may rarely occur via local spread of infection or compression from abscesses.

Pseudo-Lyre Sign.

To study the causes of the Pseudo- Lyre sign which is radiologically demonstrated in tumours other than the carotid body tumour. The study is based on an unusual case of neurofibroma of the cervical sympathetic chain presenting as a pulsatile mass in the carotid triangle in a 34 years female. Radiological investigation pointed to a diagnosis of a carotid body tumour because of typical splaying of the internal and external arteries causing the Lyre sign. At surgery, the tumour which was arising from the cervical sympathetic chain (CSC) was excised with minimum blood loss and histopathology confirmed it to be neurofibroma. This, we presume is the first ever report of a neurofibroma of the cervical sympathetic chain causing Lyre sign which we have referred to as Pseudo-Lyre sign. The various investigations which help in diagnosing the cause of Pseudo-Lyre sign have been discussed. All tumours causing Lyre sign on radio-imaging are not carotid body tumours. Other masses mostly neurogenic can demonstrate this sign and an attempt should be made preoperatively to confirm the diagnosis.

Horner syndrome as an unusual presentation of cervical radiculomyelopathy associated with cervical disc herniation: A case report.

INTRODUCTION AND IMPORTANCE: Horner syndrome, an oculo-sympathetic pathway disorder, is a very rare manifestation of cervical spine pathologies which usually present with either axial neck pain, radiculopathy, or myelopathy symptoms (or combinations of these). It is more-likely to happen in the upper cervical level involvement. CASE PRESENTATION: A 44-year-old male presented with a complaint of right eyelid drop two months before admission. The symptom was accompanied by radicular neck pain and weakness of the right upper extremity (M4) since 1 month earlier. An MRI revealed a cervical herniated disc at the C5-6 spine level. CLINICAL DISCUSSION: The patient underwent open discectomy followed by cervical disc replacement. Symptoms were significantly improved following surgery. CONCLUSION: In the presence of cervical symptoms, a focused evaluation of Horner syndrome can be done, and symptom resolution can be expected after the appropriate treatment. Otherwise, a thorough examination must be obtained to find the pathology along the tract of the oculo-sympathetic pathway and prevent irreversible neurological disturbance.

A Workout to Remember: CrossFit-Induced Vertebral Artery Dissection.

Vertebral artery dissection (VAD) is a cause of brain stem stroke in the younger population and is commonly associated with trauma, sudden neck movement, or chiropractic manipulations. In this case, a 28-year-old male with a non-significant past medical history who recently started a CrossFit boot camp presented to the emergency department with right-sided neck pain, dysarthria, mild right gaze paresis, right dysmetria, and right facial droop with symptoms of Horner's syndrome. Imaging results revealed an age-indeterminate left lateral cerebellar infarct with right VAD. The goal of management is to prevent stroke, which is done with anticoagulation and potentially thrombolytic therapy if there are no contraindications. The patient received thrombolytic therapy and was treated with conservative management. The prognosis is good for patients who survive the initial dissection and are treated in this manner. It is important to obtain a thorough history of young and healthy patients who present with concerning neurologic symptoms so that precipitating activities are not missed.

Neuro-Ophthalmological Manifestations of Horner's Syndrome: Current Perspectives.

Horner's syndrome (HS) is caused by a damage to the oculosympathetic pathway. HS may be congenital, but it is usually acquired and may reveal a life-threatening condition. According to the anatomic location of the underlying pathologic process, HS is classified as central, pre- or postganglionic, when the lesion affects the first, second or third-order neuron, respectively. Pharmacological testing, if available, can be used to differentiate HS from « pseudo-HS ¼ in patients with mild symptoms. Given the financial burden that imaging of the entire oculosympathetic pathway represents, a targeted imaging approach is advised. Although in the majority of cases, clinical examination may predict etiology, in other cases pharmacological testing can help in the localization process. We searched PubMed data base for papers published before December 2022 that concerned Horner's syndrome, its neuro-ophthalmological manifestations and diagnosis. In this article, we describe the main neuro-ophthalmological manifestations of the three types of HS, the most common etiologies, and a targeted diagnostic strategy in each type.

Horner Syndrome After Anterior Cervical Spine Surgery for Traumatic Spinal Cord Injury - A Rare Complication.

Horner syndrome (HS) is a rare complication of anterior cervical decompression and fusion procedures (ACDF). A 42-year-old female presented with sudden-onset weakness in both upper and lower limbs secondary to trauma and was diagnosed with a spinal cord injury with tetraplegia. Her pre-operative findings were that her motor level of injury was C4 on the right and C5 on the left, and her sensory level of injury was C4 and C5, respectively, on the right and left sides. Her neurological injury level (NLI) was C4, and her ASIA Impairment Scale score was A. The cervical spine MRI suggested compression fractures of the C5 and C6 vertebral bodies with cord compression. She underwent a C5 and C6 central corpectomy and mesh cage fusion by an anterior longitudinal incision via right-sided exposure. She developed ptosis, miosis, and anhidrosis on the side immediately after surgery. During rehabilitation admission, her neurological findings were that her motor level of injury was C4 on the right and C5 on the left, and her sensory level of injury was C4 and C5, respectively, on the right and left sides. Her NLI was C4, and her ASIA Impairment Scale score was C. Even one year after surgery, the symptoms persisted. HS is a rare complication of anterior cervical spine fixation, and it is essential to have a thorough understanding of intraoperative and postoperative ACDF-related complications to avoid them whenever possible and manage them successfully and safely when they occur.