Neurology Book


Horner's Syndrome

Aka: Horner's Syndrome, Horner Syndrome, Sympathetic Ocular Ophthalmoplegia
  1. Pathophysiology
    1. Paralysis of superior cervical Sympathetic Nerve
      1. Destructive lesion to superior cervical Ganglion
      2. Destruction in posterior retroparotid space
      3. Mediastinal tumor or superior Lung Mass
    2. Lesions interrupt sympathetic fibers
      1. Courses to the Carotid Artery (in petrous Temporal Bone) and then to the orbit
      2. First order Neuron injury
        1. Ipsilateral fibers from Hypothalamus, through pons and Medulla to the spinal cord C8-T2
      3. Second order Neuron injury (preganglionic sympathetic)
        1. Preganglionic sympathetic fibers from T1 to superior cervical Ganglion (C3-4)
      4. Third order Neuron injury (postganglionic sympathetic)
        1. Sweat Gland denervation (Anhidrosis) via fibers along the external Carotid Artery
        2. Long ciliary nerve denervation (Miosis) via fibers along the Internal Carotid Artery
          1. Follow Internal Carotid Artery to carotid plexus
          2. Through Cavernous Sinus (alongside CN 6)
          3. Follow CN 5 (ophthalmic branch) to eye
    3. Associated lesions
      1. Cranial Nerve 9
      2. Cranial Nerve 10
      3. Cranial Nerve 11
      4. Cranial Nerve 12
      5. Cranial Nerve 6
      6. Cranial Nerve 5
    4. Images
      1. EyePupillaryReaction.png
  2. Causes
    1. Vascular
      1. Brainstem Stroke
      2. Cerebral Aneurysm
      3. Cervical Artery Dissection
    2. Neurologic Conditions
      1. Demyelinating Disease (e.g. Multiple Sclerosis)
      2. Infection (Encephalitis, Meningitis)
    3. Posterior retroparotid space mass
      1. Parotid Gland tumor
      2. Carotid body tumor
      3. Metastatic tumor
      4. Lymphoma
      5. Tuberculous Adenitis
    4. Mediastinal Mass
    5. Apical Lung Lesion (e.g. Pancoast Tumor)
  3. Signs
    1. Mnemonic: Miosis, Ptosis, Anhidrosis
    2. All findings are unilateral
    3. Miosis
    4. Palpebral Ptosis (Incomplete)
      1. Contrast with complete Ptosis in levator paralysis
      2. Illusion of eyeball recession (No true enophthalmos)
    5. Absence of sweating (Anhidrosis) on face and neck

Horner Syndrome (C0019937)

Definition (MSHCZE) Typ periferního vegetativního syndromu, vyvíjí se při lézi horního krčního sympatiku segmentu C8-Th1 (Budgeova ciliospinálního centra) – poškození míšních kořenů, ramus communicans albus, ganglion cervicale craniale a plexus caroticus. Klinicky se projeví ptózou, miózou, enoftalmem, hyperhidrózou a hypertermií na příslušné straně tváře. CBH syndrom se může rozvinout i při poškození jader v hypothalamu a v mozkovém kmeni, je pak součástí pontinního syndromu. Tento syndrom se někdy nazývá zánikový sympatikový syndrom. Srov. Hornerova triáda. (cit. Velký lékařský slovník online, 2013 )
Definition (NCI_NCI-GLOSS) A condition in which one side of the face is flushed, does not produce sweat, and has a constricted pupil and drooping eyelid. It can be caused by an injury to, or paralysis of, nerves in the neck, or by a tumor.
Definition (MSH) A syndrome associated with defective sympathetic innervation to one side of the face, including the eye. Clinical features include MIOSIS; mild BLEPHAROPTOSIS; and hemifacial ANHIDROSIS (decreased sweating)(see HYPOHIDROSIS). Lesions of the BRAIN STEM; cervical SPINAL CORD; first thoracic nerve root; apex of the LUNG; CAROTID ARTERY; CAVERNOUS SINUS; and apex of the ORBIT may cause this condition. (From Miller et al., Clinical Neuro-Ophthalmology, 4th ed, pp500-11)
Definition (CSP) syndrome associated with defective sympathetic innervation to one side of the face, including the eye; clinical features include miosis, mild blepharoptosis, and hemifacial anhidrosis (decreased sweating); lesions of the brain stem, cervical spinal cord, first thoracic nerve root, apex of the lung, carotid artery, cavernous sinus, and apex of the orbit may cause this condition.
Concepts Disease or Syndrome (T047)
MSH D006732, D012019
ICD10 G90.2
SnomedCT 192922002, 12731000
English Bernard's syndrome, Bernard Syndrome, Bernard's Syndrome, Bernards Syndrome, Horner's Syndrome, Horners Syndrome, Syndrome, Bernard's, Syndrome, Horner's, Horner's syndrome, Syndrome, Claude Bernard-Horner, Cervical sympathetic paralysis, HORNER'S SYNDROME, Bernard Horner syndrome, Horner's syndrome (diagnosis), cervical sympathetic paralysis, cervical sympathetic paralysis (diagnosis), Ocular-Ophthalmoplegia, Sympathetic, Claude Bernard Horner Syndrome, Claude Bernard-Horner Syndrome, Syndrome, Bernard, Syndrome, Horner, Ocular Ophthalmoplegia, Sympathetic, Ophthalmoplegia, Sympathetic Ocular, Sympathetic Ocular Ophthalmoplegia, Sympathetic Ocular-Ophthalmoplegia, Ocular Ophthalmoplegias, Sympathetic, Ocular-Ophthalmoplegias, Sympathetic, Ophthalmoplegias, Sympathetic Ocular, Sympathetic Ocular Ophthalmoplegias, Sympathetic Ocular-Ophthalmoplegias, Oculosympathetic Syndrome, Oculosympathetic Syndromes, Syndrome, Oculosympathetic, Syndromes, Oculosympathetic, Bernard(-Horner) syndrome, Horner Syndrome [Disease/Finding], claude bernard-horner syndrome, sympathetic ophthalmoplegia, bernard horner syndrome, horner's syndrome, horners syndrome, horner syndrome, Bernard Syndromes, Syndromes, Bernard, Horner syndrome, Horner Syndrome, Horner, cervical; paralysis, sympathetic (syndrome), cervical; sympathetic paralysis (syndrome), cervical; syndrome, sympathetic paralysis, Bernard-Horner, paralysis; cervical sympathetic, paralysis; sympathetic, cervical, Claude Bernard-Horner, sympathetic; cervical paralysis (syndrome), sympathetic; paralysis, cervical (syndrome), sympathetic; paralysis, cervical, sympathetic; syndrome, cervical paralysis, syndrome; cervical, sympathetic paralysis, syndrome; sympathetic, cervical paralysis
Portuguese SINDROME DE HORNER, Síndrome Oculossimpática Paralítica, Síndrome Oculossimpática, Paralisia Oculossimpática, Síndrome de Bernard, Síndrome de Horner
Swedish Horners syndrome
Spanish mielopatía por parálisis de nervios simpáticos, Síndrome de Parálisis Simpáticocervical, Síndrome Oculosimpático Paralítico, Parálisis Óculosimpática, mielopatía por parálisis de nervios simpáticos (trastorno), parálisis simpática cervical, parálisis simpática cervical (trastorno), Síndrome de Bernard, Síndrome de Horner, Síndrome Oculosimpático
Japanese ホルネルショウコウグン, ベルナール・ホルネル症候群, ベルナール症候群, ホルネル症候群, 神経支配欠損性縮瞳, ホルナー症候群, 眼交感神経系症候群, Bernard-Horner症候群, 縮瞳-神経支配欠損性, Bernard症候群, Horner症候群
Czech Hornerův syndrom, Bernardův syndrom, Claude Bernardův-Hornerův syndrom, syndrom Bernardův-Hornerův, Claude-Bernardův-Hornerův syndrom, Hornerova triáda, Claude Bernardova-Hornerova triáda, CBH syndrom
Finnish Hornerin oireyhtymä
French Dystrophie sympathique cervicale, SYNDROME DE HORNER, Syndrome de Horner, Syndrome oculaire sympathique, Syndrome de Claude Bernard-Horner, SCBH, Syndrome oculo-sympathique, Syndrome oculosympathique, Syndrome sympathique cervical
German HORNER SYNDROM, Horner Syndrom, Bernard-Syndrom, Horner-Syndrom, Horner-Bernard-Syndrom, Okulopupilläres Syndrom
Italian Sindrome oculo-simpatica, Sindrome oculosimpatica, Sindrome di Claude Bernard-Horner, Oftalmoplegia oculare, Sindrome di Horner
Korean 호르너 증후군
Polish Zespół Hornera
Hungarian Horner-syndroma
Norwegian Claude Bernard Horners syndrom, Horners syndrom, Horners triade, Okulosympatisk syndrom, Sympatisk cervikaldystrofi, Cervikal sympatisk dystrofi
Dutch cervicaal; paralyse, sympathicus (syndroom), cervicaal; sympathicusparalyse (syndroom), cervicaal; syndroom, sympathicusparalyse, paralyse; cervicaal sympathisch, paralyse; sympathisch, cervicaal, sympathicus; cervicale paralyse (syndroom), sympathicus; paralyse, cervicaal (syndroom), sympathicus; syndroom, cervicale paralyse, sympathisch; paralyse, cervicaal, syndroom; cervicaal, sympathische paralyse, syndroom; sympathicus, cervicale paralyse, syndroom van Horner, Bernard-syndroom, Horner-syndroom, Oculosympathisch syndroom, Syndroom van Horner, Syndroom, Horner-
Derived from the NIH UMLS (Unified Medical Language System)

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