Horner Syndrome
Description
Horner syndrome is associated with an interruption to the sympathetic nerve supply of the eye. It is characterized by the classic triad of miosis, partial ptosis, and anhidrosis +/- enophthalmos
Horner Syndrome may occur secondary to:
- Local compression of brachial plexus and sympathetic chain by superior (pulmonary) sulcus tumors.(e.g. Pancoast tumor)
- Brainstem stroke
- Carotid artery aneurysm (dissection) or critical ischaemia
- Trauma involving the brachial plexus
- Neoplasm of the middle cranial fossa
Horner’s syndrome is present in Wallenberg syndrome, Babinski-Nageotte syndrome, Cestan-Chenais syndrome, Klumpke syndrome, Villaret syndrome, and Raeder syndrome.
History of Horner Syndrome
1727 – François Pourfour du Petit (1664-1741)
1838 – British surgeon Edward Selleck Hare (1812-1838) described the case of a man who had died of a tumour on his neck. He had for some time before death exhibited marked constriction of the left pupil and drooping of the Levator palpebrae sutperioris. The clinical case author Hare, died on September 28, 1838, a day before the communication was published.
1852 – Claude Bernard (1813-1878)
1864 – Silas Weir Mitchell (1829-1914)
1865 – Sir Jonathan Hutchinson (1828-1913)
1869 – Johann Friedrich Horner (1831-1886) reported the findings of ptosis, miosis, and enophthalmos in a 40-year-old peasant woman. He also observed increased skin temperature and dryness of the ipsilateral face.
He pharmacologically confirmed the impairment of sympathetic innervation to the eye after noting poor dilation of the affected pupil following instillation of atropine and preserved pupillary constriction to the parasympathomimetic agent calabar. [1869;7:193-198]
Original
English
Frau Anna Brändli, 40 Jahre alt, eine gesund aussehende Bäuerin mittlerer Grösse… bemerkte ein allmähliges herabsinken des rechten oberen Augenlides, das sehr langsam zunahm… Das obere Lid deckt die rechte Cornea bis an den oberen Pupillarrand… Die Pupille des rechten Auges ist bedutend enger als diejenige des linken… Nun erst erzählte uns die Patientin, dass sie rechterseits nie geschwitzt habe
Die Untersuchungen ergaben also Integrität des sensiblen Trigeminus, transitorische Lähmung des vasomotorischen Fasern im rechtseitigen Trigeminusgebiet;… (es) wundert sich Niemand, wenn ich diese… nie vollständige Ptosis als Lähmung des vom Sympathicus versorgten organischen Musc. palpebral super. ansehe.
Mrs Anna Brändli, 40 years old, a healthy looking Farmer of middle size… noticed a gradual sinking of her right upper eyelid, which was progressing slowly… The upper lid covered the right Cornea up to the edge of the pupil… The pupil of the right eye is notably smaller than that of the left… Now the patient told us that she did not sweat on the right side
The investigations demonstrated integrity of the sensory Trigeminus, transitory paralysis of the vasomotor fibres of the right Trigeminal territory… noone will be surprised if I attribute this incomplete Ptosis to a paralysis of the Levator Palpebrae superioris muscle, supplied organically by the sympathicus.
Associated Persons
- François Pourfour du Petit (1664-1741)
- Edward Selleck Hare (1812-1838)
- Claude Bernard (1813-1878)
- Silas Weir Mitchell (1829-1914)
- Sir Jonathan Hutchinson (1828-1913)
- Johann Friedrich Horner (1831-1886)
Alternative names
- Horner’s syndrome
- Bernard-Horner syndrome (France)
- Claude Bernard syndrome
- Von Passow syndrome
References
Original articles
- Petit. Sur ce que le nerf intercostal fournit des Esprits aux yeux. Histoire de l’Académie royale des sciences, 1727: 7-10
- Petit. Mémoire dans lequel il est démontré que les nerfs intercostaux fournissent des rameaux que portent des esprits dans les yeux. Histoire de l’Académie royale des sciences 1727
- Hare ES. Tumor involving certain nerves. London Medical Gazette 1838; 23: 16-18
- Ogle JW. On the Influence of the Cervical Portions of the Sympathetic Nerve and Spinal Cord upon the Eye and its Appendages, illustrated by Clinical Cases, with Observations. Med Chir Trans. 1858; 41:3 97-440
- Mitchell SW, Morehouse GR, Keen WW. Chapter IV: Wounds of special nerves; wound of the sympathetic nerve. in: Gunshot Wounds and Other Injuries of Nerves. 1864: 39-44
- Horner JF. Über eine Form von Ptosis. Klinische Monatsblätter für Augenheilkunde 1869;7:193-198
Eponymous review
- von Passow A. Okulare Paresen im Symptomenbilde des “Status dysraphicus”, zugleich ein Beitrag zur Ätiologie der Sympathikusparese (Horner-Syndrom und Heterochromia iridis). Münchener medizinische Wochenshrift, 1934; 74: 1243-1249.
- Durham DG. Congenital hereditary Horner’s syndrome. AMA Arch Ophthalmol. 1958 Nov;60(5):939-40.
FOAMed review and cases
- LITFL Clinical Case – Ophthalmology Befuddler 025
- CCC – Horner syndrome
Cite this article as: Mike Cadogan, "Horner Syndrome," In: LITFL - Life in the FastLane, Accessed on March 31, 2023, https://litfl.com/horner-syndrome/.
eponymictionary
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Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM Sir Charles Gairdner Hospital. Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |