Horner's syndrome

Description

Horner's syndrome is a condition that affects the face and eye on one side of the body. It is caused by the disruption of a nerve pathway from the brain to the head and neck.

Typically, the signs and symptoms of Horner syndrome include decreased pupil size, a drooping eyelid and decreased sweating on the affected side of the face.

Horner's syndrome may be the result of another medical problem, such as a stroke, tumor or spinal cord injury. In some cases, no underlying cause can be found. There is no specific treatment for Horner syndrome, but treatment of the underlying cause may restore nerve function.

Horner's syndrome is also known as Bernard-Horner's syndrome or oculosympathetic palsy.

Symptoms

Horner's syndrome usually affects only one side of the face. Common signs and symptoms include:

  • The persistence of a small pupil (miosis)
  • A remarkable difference in pupil size between the two eyes (anisocoria)
  • Little or delay the opening (dilation) of the affected pupil in low light conditions
  • The fall of the upper eyelid (ptosis)
  • Slight elevation of the lower lid, sometimes called upside-down ptosis
  • A sunken appearance of the affected eye
  • Little or no perspiration (anhidrosis) on the affected side of the face

The signs and symptoms, in particular, ptosis, and anhidrosis, may be subtle and difficult to detect.

Children

Other signs and symptoms in children with Horner syndrome may include:

  • The lighter color of the iris in the affected eye of a child under the age of 1
  • Color change on the affected side of the face that usually appear to heat, physical exertion, or emotional reactions

When to see a doctor

A number of factors, some more serious than others, can cause Horner's syndrome. It is important to get a prompt and accurate diagnosis.

Get emergency medical care if signs or symptoms associated with Horner's syndrome appear suddenly, appear after a traumatic injury, or is accompanied by other signs or symptoms, such as:

  • Vision disturbances
  • Dizziness
  • Speech difficulty
  • Difficulty walking
  • Muscle weakness or lack of muscle control
  • Severe, sudden headache or neck pain

Causes

Horner's syndrome is caused by damage to a certain pathway in the sympathetic nervous system. The sympathetic nervous system regulates heart rate, pupil size, sweating, blood pressure and other functions that allow you to quickly respond to changes in their environment.

The nerve pathway affected by the Horner's syndrome is divided into three groups of nerve cells (neurons).

First-order neurons

This neuron in the pathway that leads from the hypothalamus at the base of the brain, passes through the trunk and extends into the upper portion of the spinal cord. The problems in this region that can alter the function of the nerves associated with Horner's syndrome include:

  • Stroke
  • Tumor
  • The diseases that cause the loss of the protective sheath of the neurons (myelin)
  • Neck Trauma
  • Cyst in the spinal column (see syringomyelia)

The second-order neurons

This neuron path extends from the spinal column, through the upper part of the chest and on the side of the neck. - Related causes damage to the nerves in this region may include:

  • Lung cancer
  • Tumor of the myelin sheath (schwannoma)
  • Damage to the main blood vessel leaving the heart (aorta)
  • Surgery in the thoracic cavity
  • Traumatic injury

Third-order neurons

This neuron route runs along the side of the neck and leads to the facial skin and muscles of the iris and eyelids. Damage to the nerves in this region may be associated with the following:

  • The damage to the carotid artery along the side of the neck
  • The damage to the jugular vein along the side of the neck
  • Tumor or an infection near the base of the skull
  • Migraines
  • Cluster headaches, a disorder that results in cyclical patterns of severe headaches

Children

The most common causes of Horner syndrome in children include:

  • An injury to the neck or shoulders during birth
  • Defect of the aorta present at birth
  • Tumor of the hormonal and nervous systems (neuroblastoma)

Unknown causes

In some cases, the cause of Horner's syndrome can be identified. This is known as idiopathic Horner's syndrome.

Horner's syndrome

Diagnosis

In addition to a general medical examination, the doctor will probably perform tests to determine the nature of their symptoms and to identify a possible cause.

Tests to confirm the Horner's syndrome

Your doctor may be able to diagnose Horner's syndrome is based on history and an assessment of their symptoms.

An eye specialist (ophthalmologist) can also confirm a diagnosis by putting a medicated drops in both eyes, a drop to dilate the pupil of a healthy eye, not a drop, which contracts the pupil in the eye healthy. By comparison of the reactions in the healthy eye with the suspect, the eyes, the doctor can determine if nerve damage is the cause of the problems in the suspicion of the eyes.

Tests to identify the site of nerve damage

The nature of your symptoms can help your doctor to reduce the search for the cause of Horner syndrome. Your doctor may also perform additional tests or order imaging tests to locate the lesion, or irregular interruption of the nerve pathway.

Your doctor can administer a type of eye drops that will significantly dilate the eye and healthy little dilation of the affected eye if the Horner's syndrome is caused by a third-order neuron irregularity — a disruption somewhere in the neck or above.

Your doctor may order one or more of the following imaging tests to locate the site of a possible irregularity causes of Horner's syndrome:

  • Magnetic resonance imaging (MRI), a technology that uses radio waves and a magnetic field to produce detailed images
  • The magnetic resonance angiography (MRA), which is used to evaluate the blood vessels
  • Chest X-ray
  • The computed tomography (CT), specializing in X-ray technology

Treatment

There is no specific treatment for Horner's syndrome. Often, the Horner's syndrome disappears when an underlying medical condition is treated effectively.

Preparing for your appointment

In most emergency situations, they usually start by seeing a family doctor or a (ophthalmologist). You may be referred to a doctor who specializes in disorders of the nervous system (neurological) or a specialist in both neurological disorders and disorders that affect the eye and visual pathways (neuro-ophthalmologist).

What you can do

Before your appointment, make a list that includes the following:

  • Your symptoms , including any changes that cause concern
  • Key personal information , including past and recent illnesses and injuries, as well as any type of stress in your life
  • All medications, vitamins or supplements that you are taking, including dose
  • Questions to ask your provider

Have a friend or family member, if possible, to help you remember the information they give you.

Basic questions to ask your provider include:

  • What is likely causing my symptoms?
  • Other that the most likely cause, what are other possible causes of the symptoms?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • I have all the evidence of follow-up or evaluation?

If possible, bring some relatively recent photographs that were taken before the onset of symptoms to your appointment. These images can help your doctor evaluate the current condition of your affected eye.

What to expect from your doctor

Your doctor is likely to have a history of symptoms and the realization of a general medical examination. He or she is likely to ask you a series of questions, including:

  • When did you begin experiencing symptoms?
  • The symptoms changed or has gotten worse over time?
  • Do you have a history of cancer?
  • You have recently had any type of injury or trauma?
  • Have you experienced any head, neck, shoulder or arm pain?
  • Do you have a history of migraines or cluster headaches?
Symptoms and treatment of Horner's syndrome