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At least 73 records · Page 4Linked to original sources
PubMed2005

Topical apraclonidine in the diagnosis of suspected Horner syndrome.

Topical cocaine is used to confirm the clinical diagnosis of ocular sympathetic denervation, or Horner Syndrome (HS). Cocaine blocks re-uptake of norepinephrine (NE) by sympathetic nerve terminals in the iris dilator muscle, transiently increasing its concentration in the synaptic junction. Norepinephrine activates alpha1 receptors in the iris dilator to cause pupil dilation. In HS, cocaine fails to dilate the affected pupil as much as the unaffected pupil, but its indirect action makes it a weak dilator, and the test can give equivocal results. Cocaine is also a controlled substance and therefore difficult to obtain. A practical and reliable alternative to cocaine is apraclonidine, an ocular hypotensive agent that has a weak direct action on alpha1 receptors and therefore minimal to no clinical effect on the pupils of normal eyes. Patients with HS have denervation supersensitivity of the alpha1 receptors in the iris stroma of the affected eye, making the pupil dilator responsive to apraclonidine. In patients with HS, reversal of anisocoria occurs after bilateral instillation of apraclonidine 1% or 0.5%. Two cases that demonstrate this effect are reported. Apraclonidine should be considered a candidate to replace cocaine in the pharmacologic diagnosis of HS if a gold-standard comparison study confirms these results.

Administration, Topical↗
PubMed1986

Chest-tube thoracostomy causing Horner's syndrome.

Horner's syndrome developing early after lung biopsy is reported in a 42-year-old woman. At the end of the procedure a thoracostomy tube was inserted with its tip at the T1-2 posterior intercostal space. The authors conclude that direct injury to the second order preganglionic neuron in the vicinity of the stellate ganglion caused the Horner's syndrome. They recommend placing the tip of the thoracostomy tube below the level of the second rib posteriorly to prevent this complication.

Adult↗
PubMed1980

Horner syndrome with causalgia.

A previously healthy man presented with burning pain in the chest wall and arm; there was Horner syndrome on the same side. After extensive investigation, the disorder was attributed to a foraminal osteophyte involving the left T1 spinal root.

Causalgia↗
PubMed1999

Traumatic Horner syndrome without anhidrosis.

In a patient with a traumatic avulsion of the arm, magnetic resonance imaging showed the exact site of the lesion that produced Horner syndrome with preservation of sweating on the face.

Adult↗
PubMed1995

[Photo- and videographic determination of the dilatation deficit in differential diagnosis of Horner syndrome].

Physiological anisocoria, a very frequent condition among normal subjects, must be differentiated from Horner's syndrome. Aside from a history including evaluation of older photographs, pharmacological pupil testing with cocaine eye drops has been the "gold standard". Measurement of dilation lag, occurring in Horner's syndrome, is much less common and normal values are missing. Therefore, we evaluated various photographic parameters for testing for the best parameter to discriminate Horner's syndrome (22 patients) from physiological anisocoria (16 patients). Additionally, we tested whether a commercially available camcorder is sufficient to record pupillary dilatation lag. An anisocoria of 0.6 mm or more 4s after switching off the illumination discriminates physiological anisocoria from Horner's syndrome with a sensitivity of 82% and a specificity of 69%. A dilatation speed of 1.1 mm/4 s shows the same ability to differentiate in anisocoria and does not provide any better results. Because of the good correlation between post-cocaine anisocoria and anisocoria after 4 s in darkness, photographic or videographic measurements of the pupillary dilatation lag may complete or in some cases even replace cocaine testing.

Adolescent↗
PubMed1994

[Pholedrine for determining the site of Horner syndrome].

BACKGROUND: Pharmacologic testing by indirect acting sympathomimetics like hydroxyamphetamine may determine the site of the lesion in Horner's syndrome. Pholedrine is chemically similar to hydroxyamphetamine. Therefore we examined if it shows the same effects in normal subjects and in patients with Horner's syndrome. METHODS: Pupil diameter was measured by means of standardized photography before and after single and with different intervals repeated administration of pholedrine eye drops in normal subjects. In 18 patients with Horner's syndrome and known hydroxyamphetamine test results, a pholedrine test was carried out analogous to the hydroxyamphetamine test. RESULTS: Pholedrine dilates the normal pupil by 2.2 mm (mean). It acts at the longest 8-10 hours with maximal effect between 20 and 90 minutes. After this period its effect decreases rapidly. It acts independently from age and from baseline pupil diameter. Given repeatedly the second administration reaches the same mydriatic effect as the first only if the interval between both applications is 72 hours or more. This is because it needs some time to refill the noradrenaline stores in the sympathetic neuron innervating the dilator muscle of the pupil. In Horner's syndrome pholedrine dilates the involved pupil only minimally in case of a postganglionic lesion, and in case of a preganglionic lesion it dilates the pupil even slightly more than the normal fellow pupil. It shows the same effect as hydroxyamphetamine. There are only few side effects. CONCLUSION: Pholedrine is a substitute for hydroxyamphetamine to localize the site of the lesion in patients with Horner's syndrome.

Adolescent↗
PubMed2005

Coexisting harlequin and Horner syndromes after high thoracic paravertebral anaesthesia.

A patient undergoing left mastectomy and immediate latissimus dorsi breast reconstruction under combined paravertebral block and general anaesthesia developed transient, well-demarcated, right-sided hemifacial erythema and sweating, and left-sided Horner syndrome postoperatively. This "harlequin" appearance occurs because of a normal or excessive vasodilatory, thermoregulatory response to heat or emotion mediated by an intact sympathetic pathway on the erythematous side, together with relative pallor of the pharmacologically blocked side.

Anesthesia, General↗
PubMedDate not supplied

Horner syndrome: a rare complication of internal jugular vein cannulation.

Percutaneous cannulation of the internal jugular vein is a widely used and accepted method for central venous cannulation, used for parenteral alimentation, fluid administration, and measurement of pressures. A multitude of complications associated with this procedure have been described. Horner syndrome as a rare complication of internal jugular vein cannulation is presented.

Adolescent↗
PubMedDate not supplied

Paraneoplastic cerebellar degeneration and Horner syndrome: association of two uncommon findings in a child with Hodgkin disease.

An 11-year-old boy admitted with a right cervical mass was found to have Hodgkin disease. On admission, he also had right Homer syndrome and severe cerebellar ataxia. Cranial MRI revealed marked cerebellar atrophy. He was treated with chemotherapy consisting of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), in addition to radiotherapy. Three months after initiation of therapy, he had a partial remission of tumor. Neurologic symptoms improved dramatically after chemotherapy started. Hodgkin disease should be included in the differential diagnosis of children with cerebellar findings and Horner syndrome.

Child↗
PubMed1997

Horner syndrome as an isolated manifestation of an intrapetrous internal carotid artery dissection.

PURPOSE: To describe the atypical localization and unusual clinical manifestation of an internal carotid artery dissection. METHODS: We examined a 43-year-old woman who had sudden onset of left ptosis and miosis with vague dysesthesia around her eye. RESULTS: Her examination showed an intrapetrous carotid artery dissection. CONCLUSIONS: The intrapetrous segment is an extremely rare localization for an internal carotid artery dissection. The differential diagnosis of acute Horner syndrome should include carotid dissection, which is usually accompanied by other neurologic manifestations.

Adult↗
PubMed1993

[Claude Bernard-Horner syndrome following percutaneous catheterization of the jugular vein in an infant].

A case of Horner's syndrome is reported in a 8 month-infant after ultrasound guided, percutaneous internal jugular cannulation. This syndrome receded spontaneously after resolution of a laterocervical hematoma caused by reiterated venipunctures performed during the cannulation. Ultrasound imaging, by providing vizualization of the internal jugular vein and surrounding structures, may help to localize the vein and decrease the incidence of complications. Considering this case report and the cases previously reported in literature, the authors conclude that paediatric patients are at a higher risk compared to adults to develop Horner's syndrome following percutaneous internal jugular cannulation.

Catheterization, Peripheral↗
PubMed1995

[Photographic pupil diagnosis in Horner syndrome].

In cases of miosis without other clinical signs and not contributory medical history it is often hard to differentiate Horner's syndrome. In these cases the pharmacological testing with cocaine eye drops is a well established and validated method. The physiological testing, i.e. the detection and measurement of a dilatation lag in Horner's syndrome, is not so common. For this reason we measured the dilatation of pupils in 22 Horner's syndromes and 16 physiological anisocorias to find limit ("cut off") values. We used flash photography and a commercial available camcorder and took photos in bright light (400 cd/m2) as well as 4 and 15 seconds after cessation of light stimulus in darkness. An anisocoria after 4 seconds of darkness greater than 0.6 mm distinguishes both groups with a sensitivity of 82% and a specifity of 69%. A dilatation speed of the smaller pupil during the first 4 seconds of darkness lower than 1.1 mm/4 sec is also a good threshold value. Because of the additional good correlation of these parameters to the anisocoria after cocaine the photographic methods are at least a supplement to pharmacological testing with cocaine, which is sometimes equivocal and always delays the localizing hydroxyamphetamine test. The advantage of using a camcorder is the immediate evaluation on a TV screen. Because of the similar price it is more useful to buy an infrared camera to perform real pupillography. Because of the missing possibility of magnification we prefer the evaluation of slides instead of Polaroid flash photographs.

Adolescent↗