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Congenital (?) Horners syndrome and ipsilateral headache.

A 31-year-old woman had left-sided miosis, ptosis, and hypopigmented iris probably since birth. At 22, she developed intermittent headaches, always in the left frontotemporal region. These headaches lasted from 1 to 2 days and recurred every 1-2 months. Pain attacks were pressing-pulsatile in character, moderate in intensity, and frequently accompanied by nausea, vomiting, and moderate phono- and photophobia. Various treatment alternatives, such as conventional analgesics and ergotamine failed to improve the attacks. Pizotifen was partially effective. The results of pupillometry and evaporimetry studies were consistent with a 3rd neuron sympathetic hypofunction on the symptomatic side. Autonomic studies and clinical features were consistent with a congenital Horner's syndrome. Conceivably, a sympathetic hypofunction may play a role in the pathogenesis of such headache or in its lateralization. Indomethacin and sumatriptan both seemed to provide absolute pain relief. Some clinical features, the fact that the IHS criteria for migraine are fulfilled and that sumatriptan is efficient, demonstrate the similarity to migraine. The coexistence of strict unilaterality of pain and the probable, complete response to indomethacin indicate a similarity to hemicrania continua in its remitting form. Further information on the effect of sumatriptan in hemicrania continua will help clarify the position of this case vs. hemicrania continua. At this stage, it is probably not possible to classify this case properly.

Adult↗
PubMed1986

[Claude Bernard-Horner syndrome and lumbar epidural analgesia].

Lumbar epidural analgesia was performed in a 28 year old primigravida through a L2-L3 catheter. The first dose induced satisfactory analgesia for 1 h. After the second dose of 8 ml of 0.25 bupivacaine, the patient's systolic blood pressure fell from 110 to 80 mmHg. As vena caval compression can contribute to hypotension, the patient was immediately placed in the left lateral position and oxygen was administered through a mask. Rapid infusion of 250 ml of modified gelatin resulted in a prompt and lasting restoration of blood pressure to its initial level. The third dose of 8 ml of 0.25% bupivacaine produced satisfactory analgesia without any adverse effect. The last dose (4 ml of 0.50% bupivacaine administered with the patient in half sitting) gave a left-sided Horner's syndrome and weakness in the left arm. An epidurogram, performed through the catheter 2 h after delivery, with the patient lying supine, showed unilateral left spread ascending to upper thoracic levels with delayed spread toward the right lumbar epidural space. The troubles persisted 6 h after the final bupivacaine dose, then resolving completely.

Adult↗