Clinical

Condition
Horners
Syndrome

Description

Epidemiology

Etiology

Horners
syndrome (also
called
oculosympathetic
paresis, or Horner
syndrome)
comprises a
constellation of
clinical signs
including the
classic triad
of ptosis, miosis
and anhidrosis. It
results from a
lesion to the
sympathetic
pathways that
supply the head
and neck region.

Incidence of
Horners
syndrome was
estimated to
be 1.42 per
100 000
patients
younger than
19 years, with
a birth
prevalence of
1 in 6250 for
those with a
congenital
onset.

Central (first
order)
Horners:
Lesions of the
hypothalamus,
brainstem and
spinal cord,
stroke, tumor,
neck trauma,
syringomyelia
Preganglionic
(second order
neuron)
Horners:
Lesions of
thoracic outlet,
mediastinum,
pulmonary
apex, neck or
thoracic spinal
cord or surgical
procedures in
this region,
lung cancer,
schwanomma,
surgery in chest
cavity
Third order
neuron:
Lesions of
superior
cervical

Signs & Symptoms

Iris
heterochromia
in children
Anhidrosis
Mild ptosis of
upper lid
Inverse ptosis
of lower lid
Anisocoria
with the ptotic
eye having
the smaller
pupil
Extraocular
movements
Brachial
plexopathy

Clinical
manifestations
Ptosis
Miosis of
the ptotic
eye
Dilation
lag in
affected
eye

Lab Tests

Topical Cocaine
eye test
Topical
Apraclonidine test
Topical Hydroxy
amphetamine test
Magnetic
resonance
imaging (MRI)
Computed
tomography (CT)
of brain, spinal
cord, chest, or
neck

Mana

For op
manag
under
follow
consu
requir

Erbs palsy

Erbs palsy, a
form of obstetric
brachial plexus

One or two
out of every
1,000 babies

disorder, is an
injury that occurs
when the nerves

in the upper arm

are damaged.

ganglion,
internal carotid
artery in the
neck and skull
base, lesions of
ICA in the
cavernus sinus
and of the
sellar and
parasellar
regions.
Birth trauma or
neck trauma
Surgical trauma
Neuroblastoma
Brainstem
lesions
Carotid artery
thrombosis
Difficult or
obstructed
childbirth
(shoulder
dystocia)
Excessive
pulling on
shoulders
(cephalic
presentation)
Motorbiking
accidents
Clavicle

Weakness in
one arm
Loss of
feeling in the
arm

Partial or
total
paralysis
of the
arm
Waiters
tip
defprmit
y

Physical exam
X-ray
U;trasound
imaging
Electromyogram
Nerve conductin
study


Klumpkes
palsy

a brachial plexus
injury that affects
newborns by
interfering with
the network of
nerves in this
area by sending
impulses from
the babys spine
down to their
shoulder, arm
and finally to the
bottom of the
spine.

fractures
Gunshot or stab
injuries
Nerves being
stretched,
compressed or
torn
Accidents
Pulling babys
arms out with
too much force
during vaginal
birth
Diabetic
neuropathy
Cervical
spondylosis
Alcoholic
neuropathy
Skin scarring
Inadequate
passageway for
nerves and
blood vessels
as they pass
through
thoracic outlet
Weight lifting
Obesity
Chest tumors
Extra ribs
Poor posture

Severe pain
Weakness of
shoulder, arm
Stiff joints
Ptosis and
miosis

Neck,
shoulder and
arm pain
Numbness in
fingers
Impaired
circulation
Discoloration
in extremities

Claw
hand

Physical exam
Electromyograph
y

Adsons
maneuver
Electromyogram
Somatosensory
evoked responses
Angiogram
X-ray tests


Thoracic
outlet
syndrome
Radiculopathy
Proximal
humerus
fracture
Pronator teres
syndrome
Neurapraxia
Neurotmesis
Obstetric
brachial
plexus injury

Pregnancy