infant with right Horner syndrome, demonstrating ipsilateral upper lid ptosis, "upside-down" ptosis of the lower lid, and anisocoria, with the right pupil smaller than the left. Both pupils reacted briskly to light stimulation. 

infant with right Horner syndrome, demonstrating ipsilateral upper lid ptosis, "upside-down" ptosis of the lower lid, and anisocoria, with the right pupil smaller than the left. Both pupils reacted briskly to light stimulation. 

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Sivashakthi Kanagalingam,1–3 Neil R Miller1–31Department of Ophthalmology, 2Department of Neurology, 3Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USAAbstract: Horner syndrome consists of unilateral ptosis, an ipsilateral miotic but normally reactive pupil, and in some cases, ipsilateral facial anhidrosis, all resulting fr...

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... causes of Horner syndrome in children are usually classified as congenital or acquired (Figure 4). In addition to iris heterochromia, infants with Horner syndrome can demonstrate contralateral hemifacial flushing and ipsilat- eral hypohidrosis, called Harlequin syndrome. ...

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... The precise incidence of each etiology of Horner syndrome differs across major published studies, but the most common etiologies include tumors, cerebral vascular accidents, and iatrogenic causes such as thoracic and cervical procedures. 3,4 The etiologies of Horner syndrome can be divided based on anatomical distribution. The first-order neurons are generally affected by intracranial processes including cerebral vascular accidents (CVA), meningitis, encephalitis, intracranial tumors, and spinal trauma above T2-T3. ...
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IntroductionHorner syndrome is a rare complication following anterior cervical discectomy and fusion (ACDF) surgeries, with an incidence rate of Case DescriptionWe report a case of a 45-year-old female with a history of non-Hodgkin's lymphoma and chronic obstructive pulmonary disease who developed Horner syndrome post-ACDF. Initially admitted for suspected cholecystitis found on imaging following a fall, the patient's clinical course was complicated by worsening cervical and lumbar pain. This prompted MRI evaluation revealing cervical stenosis at C5-C6 and ACDF was performed without intraoperative complications. However, on postoperative day three, the patient developed left eye ptosis and miosis, consistent with Horner syndrome. Subsequent MRI revealed a new fluid collection suggestive of a seroma. Despite conservative management, Horner syndrome persisted. Discussion Horner syndrome post-ACDF is a rare but potentially lifelong complication. Possible etiologies include prolonged retraction of the longus colli muscle and postoperative inflammation leading to seroma formation, potentially compressing sympathetic nerve fibers. Current literature suggests under diagnosis of Horner syndrome post-ACDF, emphasizing the need for heightened clinical suspicion. Future research should focus on refining surgical techniques to minimize sympathetic trunk damage and facilitate early diagnosis and management of this rare complication.
... Оценивая синдром Горнера, важно помнить, что при ярком свете парасимпатический тонус минимален, а симпатический -максимален, поэтому анизокория может быть незаметна. В темноте зрачок расширяется за счет релаксации сфинктера (пассивно), медленно, что приводит к возникновению феномена dilation lag (задержка расширения зрачка); рис. 4 [31]. Наряду с ипсилатеральной атаксией и контралатеральной гипестезией синдром Горнера входит в клиническую триаду ЛМИ, предложенную R. Sacco и соавт. ...
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Wallenberg–Zakharchenko syndrome associated with lateral medullary infarction has been known to neurologists since the end of the 19th century. However, to this day, its diagnosis is challenging due to the polymorphic, atypical, and rapidly changing clinical manifestations. Timely verification of the syndrome provides essential information regarding its etiology and also prevents serious complications. The paper presents clinical and anatomical correlates of lateral medullary infarction, its etiology, features of the clinical presentation, complications, and prognosis. In conclusion, a diagnostic algorithm that can be used in everyday practice is given.
... A lesion along the sympathetic chain (descending from the hypothalamus to the upper spinal cord, over the lung apex, and ascending to the cavernous sinus and orbit) should be excluded. 1,4 Carotid dissection can cause a painful Horner syndrome, and can be identified on CTA of the head and neck. 1,4 In children, a magnetic resonance imaging scan of the brain, neck, and chest should be done to rule out neuroblastoma or other malignancy. ...
... 1,4 Carotid dissection can cause a painful Horner syndrome, and can be identified on CTA of the head and neck. 1,4 In children, a magnetic resonance imaging scan of the brain, neck, and chest should be done to rule out neuroblastoma or other malignancy. 1,4,5 Practice | Five things to know about ... ...
... 1,4 In children, a magnetic resonance imaging scan of the brain, neck, and chest should be done to rule out neuroblastoma or other malignancy. 1,4,5 Practice | Five things to know about ... ...
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... The causes can be stratified depending on the location of sympathetic innervation disruption has taken place: first-order neuron causes are typically intracranial, second-order neuron causes are in the thoracic region, and third-order neuron causes are typically near the cavernous sinus. (13) Pseudo-enophthalmos, or the appearance that the eye has been posteriorly displacedin the orbit, may also be observed.(13) ...
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Question A 75-year-old male presents to the ophthalmology service with a drooping left upper eyelid. Upon further questioning, he states that he feels his visual acuity has deteriorated in the left eye, but only in the dark. On testing his best corrected visual acuity is 20/25 in the right eye and 20/30 in the left eye. His pupils are equal, round, and reactive to light and accommodation. His intraocular pressures are 14mmHg bilaterally. His past medical history is significant for type 2 diabetes mellitus, hypertension, hypercholesterolemia, and obesity. He states that his dropping eyelid does not get better or worse during the day and he first noticed his drooping eyelid this morning. He also states that he has been experiencing some horizontal diplopia since this morning. Your clinical examination reveals no significant ocular misalignment, but the patient is unable to fully adduct, infraduct, or supraduct his left eye. His margin to reflex distance 1 is 2mm and his levator function is markedly decreased. His ESR and CRP are within normal limits. He is scheduled for a follow-up visit in 6 weeks at which point his symptoms have almost completely resolved. Third Nerve palsy Myasthenia gravis Congenital ptosis Horner syndrome Aponeurotic ptosis Answer A) Given his history and clinical examination, this patient likely has a third cranial nerve palsy. Furthermore, given no pupillary involvement and systemic risk factors (obesity, diabetes mellitus, hypertension, hypercholesterolemia), an ischemic third nerve palsy is favoured. Typically, ischemic third nerve palsies are self-resolving and the patient can be scheduled for follow-up in 4-6 weeks. Pupil involvement or a lack of improvement at follow-up are indications for head imaging (CT angiography) to rule out an aneurysm or other compressive causes. In this case, since the ptosis does not worsen as the day goes on and improve after rest, myasthenia gravis is unlikely. Additionally, this autoimmune condition would present at an earlier age than 75. Similarly, congenital ptosis would present in the first years of life. Horner syndrome would include miosis and facial anhidrosis alongside the ptosis. Aponeurotic ptosis is a possible diagnosis, however, is less likely given this presentation with an inability to fully adduct, infraduct, or supraduct his left eye.
... These anatomical structures were located near the DSCT and LVST. Ipsilateral Horner syndrome is also a candidate accompanying sign if the descending oculosympathetic pathway in the lateral area of the medulla oblongata is damaged (4,6,8,9). Other studies have identified visual vertical misperception (10) and ocular lateropulsion (8). ...
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A 69-year-old man was admitted to our hospital because of a sudden gait disturbance. Based on the neurological examination performed upon admission, the patient exhibited ataxic movement in his right lower limb and body lateropulsion toward the right side. Magnetic resonance imaging revealed a lower lateral medullary infarction limited to the lateral surface. A motion analysis revealed ipsilateral lower-limb ataxia. Lower lateral medullary infarction can cause ipsilateral lower limb ataxia, particularly impaired hip joint coordination, resulting in body lateropulsion in dynamic conditions.
... Horner's syndrome results from damage to the ipsilateral oculosympathetic pathway. Lung, breast, and mediastinum tumors, as well as neck injuries may cause the syndrome due to direct compression of the oculosympathetic pathway [5]. However, cardiovascular surgery can also cause Horner's syndrome. ...
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Background Horner’s syndrome is a rare complication of cardiovascular surgery. A bone fragment and hematoma due to rib fracture after cardiac surgery may cause injury to the brachial nerve plexus and sympathetic nerve trunk, leading to neurologic disorders and Horner’s syndrome. However, few reports have revealed the etiology of Horner’s syndrome after cardiovascular surgery based on imaging. Herein we present a case in which a plain CT scan confirmed the etiology of Horner’s syndrome after coronary artery bypass grafting (CABG), reviewing 139 CABG cases retrospectively in our hospital and 6 case reports of Horner’s syndrome associated with cardiovascular surgery. Case presentation A 69-year-old woman with a history of percutaneous coronary intervention and total abdominal hysterectomy with bilateral salpingo-oophorectomy had chest pain on exertion. Coronary angiography showed severe triple vessel disease. She underwent off-pump coronary artery bypass grafting (CABG). A median sternotomy was performed, and the split sternums were widened using a sternal retractor. The bilateral internal thoracic arteries were harvested. A triple CABG was performed. She had left shoulder pain after surgery. She complained of anhidrosis involving the left face and hyperhidrosis involving the right face from postoperative day (POD) 6. Left ptosis and blurry vision appeared after discharge from the hospital, for which she saw a neurologist in our hospital on POD 48. Miosis could not be clearly confirmed. She was diagnosed with Horner’s syndrome. A plain CT scan revealed displaced fractures of the bilateral first ribs and left second rib. The bone fragment of the left first rib head was displaced 3 mm anteriorly compared to the left first rib head before surgery, which suggested that the fragment affected the stellate ganglion in the sympathetic trunk. The patient had regular follow-up evaluations. The anhidrosis persisted, but the ptosis improved, and the miosis was not confirmed at the 6-month follow-up evaluation. Conclusions We should recognize that Horner’s syndrome is one of the complications of cardiovascular surgery, especially CABG. Fracture of the first rib head with a displaced bone fracture was shown to be a contributor to ipsilateral Horner’s syndrome. When symptoms of Horner’s syndrome and other neurologic symptoms are noted after open heart surgery, a plain CT examination should be obtained.
... Pupil diameters should be measured in room light at baseline and 40-60 minutes after the test; a difference of >0.8 mm is considered significant. 6,7 As an effective substitute for cocaine, apraclonidine, an α2-adrenergic receptor agonist with modest α1 action, has the benefit of being readily available. Individuals identified as having HS display denervation supersensitivity of the α1 receptors on the affected eye's dilator muscle. ...
... Congenital tumours, postviral damage, internal carotid artery agenesis, hypoplasia, and fibromuscular dysplasia are among other etiologies. 6 ...
... Neuroblastoma is the most common occult malignancy associated with Horner syndrome, with an incidence of one in 7,000 children younger than the age of 5 years. 6 Horner syndrome may be examined as a possible diagnosis if a patient exhibits anisocoria and what seems to be normal pupillary constriction to light in both the more significant and smaller pupil. If the smaller pupil's dilation lag is present, it aids in the diagnosing process as well. ...
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p> Aim : The purpose of the case report was to highlight the various features of Horner syndrome to aid in diagnosing this syndrome, which has classic clinical features like miosis, ptosis, and anhidrosis, along with poor oral hygiene and carious teeth. Background : Francois Pourfour du Petit originally defined the disease in 1727 when discussing the outcomes of an animal experiment in which intercostal nerves were removed, and the ipsilateral eye and face were the subsequent subjects of modifications. Claude Bernard, a French physiologist, provided a more detailed description of it in 1852 Case report : Thus, to highlight the features of Horner syndrome, we are presenting a case report of a 6-year-old female child who reported to the department with a chief complaint of pain in the lower correct back teeth region. There was no significant prenatal or postnatal history. Article visualizations: </p
... First described in animals by Claude Bernard (1854), the syndrome was identified in humans in 1863 by Weir-Mitchell and colleagues. However, it was not until 1869 that the Swiss ophthalmologist Johann Friedrich Horner (1831-1886) attributed it to oculo-sympathetic paresis (Kanagalingam, 2015;Jeffery et al., 1998). The palsy manifests when lesions of one of the three neurons forming the oculosympathetic pathway (the central neuron, the preganglionic neuron, or postganglionic neuron) occur the pupil and the eyelids is interrupted (Kanagalingam & Miller, 2015;Jeffery et al. 1998). ...
... However, it was not until 1869 that the Swiss ophthalmologist Johann Friedrich Horner (1831-1886) attributed it to oculo-sympathetic paresis (Kanagalingam, 2015;Jeffery et al., 1998). The palsy manifests when lesions of one of the three neurons forming the oculosympathetic pathway (the central neuron, the preganglionic neuron, or postganglionic neuron) occur the pupil and the eyelids is interrupted (Kanagalingam & Miller, 2015;Jeffery et al. 1998). ...
... Depending on the affected neuron, a first order HS, second order HS, or third order HS, is diagnosed (Kanagalingam & Miller, 2015;Jeffery et al., 1998). In general, the first and third order neurons are more often involved in adults whereas, in paediatric patients, the second order neuron is the most likely. ...
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One of the most important characteristics, which determine facial appearance, is eye colour. Among the different conditions that causes an alteration in the normal iris pigmentation is congenital Horner Syndrome. Here we describe a case of right unilateral segmental heterochromia iridum in the 16th to 17th century “Portrait of an unknown soldier” displayed at the Ferdinandeum Tyrolean State Museum (Innsbruck, Austria). Along with heterochromia, the sitter also displays right anisocoria, miosis, and mild ptosis of the upper and lower lids. This case highlights the interest of artists for modification of facial appearance in order to represent the sitter in the most possible realistic way.
... The oculosympathetic pathway is damaged in this condition, resulting in these three hallmark symptoms. The first-order neurons are located in the hypothalamus and pass through the lateral brainstem [1]. The preganglionic sympathetic neurons then pass the pulmonary apex and travel to the stellate ganglion via the carotid sheath, reaching the superior cervical ganglion. ...
... The preganglionic sympathetic neurons then pass the pulmonary apex and travel to the stellate ganglion via the carotid sheath, reaching the superior cervical ganglion. Around 44% of cases involving Horner's syndrome entail the preganglionic sympathetic neurons [1]. Thoracostomy, stellate ganglion block, and tumor excisions are procedures that can elicit symptoms. ...
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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.