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While performing the anterior approach to the cervical vertebral bodies, injury to important anatomic structures in the vicinity of the dissection represents a serious risk. The midportion of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve are encountered in the anterior approach to the lower cervical spine. The recurrent laryngeal nerve is vulnerable to injury on the right side, especially if ligation of inferior thyroid vessels is performed without paying sufficient attention to the course and position of the nerve, and the external branch of the superior laryngeal nerve is vulnerable to injury during ligature and division of the superior thyroid artery. Avoiding injury to the recurrent laryngeal nerve (especially on the right side) and superior laryngeal nerve is a major consideration in the anterior approach to the lower cervical spine. The sympathetic trunk is situated in close proximity to the medial border of the longus colli at the C6 level (the longus colli diverge laterally, whereas the sympathetic trunk converges medially). The damage leads to the development of Horner's syndrome with its associated ptosis, meiosis, and anhydrosis. Awareness of the regional anatomy of the sympathetic trunk may help in identifying and preserving this important structure while performing anterior cervical surgery or during exposure of the transverse foramen or uncovertebral joint at the lower cervical levels. Finally, the spinal accessory nerve (embedded in fibroadipose tissue in the posterior triangle of the neck) is prone to injury. Its damage will result in an obvious shoulder droop, loss of shoulder elevation, and pain. Prevention of inadvertant injury to the accessory nerve is critical in the neck dissection.
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PMID:Anterior approach to the cervical spine: surgical anatomy. 1095 48

Homer's syndrome, which classically presents as ipsilateral ptosis, meiosis, and facial anhydrosis, may present as a consequence of thoracic epidural analgesia. Pain that limits the patient's ability to maintain adequate pulmonary mechanics may optimally be treated with a thoracic epidural. The importance of recognition of a Horner's syndrome in such a patient is critical in preventing unnecessary anxiety for the patient and potentially embarking on an unnecessary diagnostic workup. The following is a case presentation of a patient who sustained multiple rib fractures in an automobile accident. The patient presented with a Horner's syndrome after a thoracic epidural infusion had begun. This article highlights the importance of early recognition of this benign, transient syndrome and discusses the pathways and potential mechanism of this process.
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PMID:Transient Horner's syndrome in a trauma patient with thoracic epidural analgesia: a case report. 1096 35

An adult domestic female pig (Sus scrofa) exhibited clinical signs of right-sided Horner's syndrome after experimental placement of a woven aortic stent followed by aortic catheterization. The clinical signs included a miotic pupil, ptosis of the upper eyelid, prolapse of the nictitating membrane, and enophthalmos. Necropsy revealed a large mass in the right midcervical region that encased or was in contact with the carotid artery, internal jugular vein, and vagus nerve. Closer evaluation of the mass revealed that it was a small piece of surgical suture material that was embedded within the lumen of the carotid artery. This extrinsic material served as a nidus for an inflammatory reaction involving the vagus nerve.
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PMID:Iatrogenic Horner's syndrome in an experimental pig. 1130 Jun 74

Seven cases of idiopathic Horner's Syndrome in the Collie are described. Five males and two females presented with unilateral miosis, ptosis of the upper eyelid, enophthalmos and protrusion of the third eyelid. Thorough examination, pharmacological testing with phenylephrine, complete blood counts and radiography of the tympanic bullae and thorax were performed. The etiology was not identified in any of the cases. Clinical signs improved with pharmacologic testing within 20-40 min. In five dogs, total resolution of clinical signs was observed at 4 and 16 weeks after their initial appearance. Pharmacological testing suggested that the deficit could be at the preganglionic neuron.
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PMID:Idiopathic Horner's syndrome in collie dogs. 1139 4

Horner's syndrome is described in a patient with anisocoria and unilateral lid ptosis 48 hours after an ipsilateral carotid endarterectomy. This case illustrates a rare iatrogenic complication of sympathetic nerve dysfunction following elective surgery.
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PMID:Horner's syndrome after carotid endarterectomy--a case report. 1158 60

Although oculosympathetic lesions were described in the early 18th century in animal experiments, detailed description in humans, with the well-known triad of miosis, ptosis and enophthalmos comprising Horner's syndrome, is accredited to the Swiss ophthalmologist Friedrich Horner (1831-1886). This paper briefly reviews the symptoms and localization of the lesion with currently available diagnostic aids, and sketches the eponymous life behind Horner's syndrome.
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PMID:The man behind the syndrome: Friedrich Horner. 1161 33

Horner syndrome is defined as homolateral miosis, ptosis and enophthalmus, and occurs after a lesion of central or peripheral sympathetic pathways. The syndrome is mentioned as side effect for example with dysraphias, the Wallenberg syndrome, ischemic stroke of the middle cerebral artery, mediastinal tumors or iatrogen after pneumothorax interventions. We recently observed a patient with a transient significant miosis, without ptosis and enophthalmus, which we interpreted as an incomplete manifestation of a Horner syndrome occurring with spontaneous pneumothorax.
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PMID:[Horner's syndrome occurring with spontaneous pneumothorax. A case report]. 1175 51

A 17-year-old male presented with a wound on the right temporal region, oozing hemorrhagic necrotic brain tissue and cerebrospinal fluid, following a fall. Computed tomography showed temporoparietal and petrous apex fractures on the right. Neurological examination revealed abducens nerve paresis, ptosis, and myosis on the right side. The patient was treated surgically for the removal of the free bony fragments at the fracture site and to close the dural tear. The abducens nerve paresis, ptosis, and myosis persisted at the 3rd monthly postoperative follow-up examination. The anatomy of the abducens nerve at the petroclival region was studied in four cadaveric heads. Two silicone-injected heads were used for microsurgical dissections and two for histological sections. The abducens nerve has three different angulations in the petroclival region, located at the dural entrance porus, the petrous apex, and the lateral wall of the cavernous segment of the internal carotid artery. The abducens nerve had fine anastomoses with the trigeminal nerve and the periarterial sympathetic plexus. There were fibrous connections extending inside the venous space of the petroclival area. The abducens nerve seems to be vulnerable to damage in the petroclival region, either directly by trauma to its dural porus and petrous apex or indirectly by stretching of the nerve through the nervous and/or fibrous connections. Concurrent functional loss of the abducens nerve and the periarterial sympathetic plexus clinically manifested as incomplete Horner's syndrome in our patient.
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PMID:Isolated abducens nerve paresis associated with incomplete Horner's syndrome caused by petrous apex fracture--case report and anatomical study. 1176 Mar 84

An increasing number of complications are being noted with the widespread use of oral contraceptives (OCs). In opthalmology, migraine like headaches are frequently encountered. This report presents observations of 4 different neurological manifestations in 4 different individuals in addition to the headache for which they were referred to the Neuro-Ophthalmology Clinic of the Philippine General Hospital. The 4 cases clearly demonstrate that aside from the headache neuro ophthalmologic abnormalities can occur during OC use: left facial paresis, left Horner's syndrome, bilateral ptosis, and left mydriasis. The abnormalities disappeared on withdrawal of the OCs, suggesting that they are caused by the drug. They were reversible after 2 months to 4 years of medication. OCs are combinations of semisynthetic progesterone and estrogen. A study of 2 of the cases suggests that the estrogen portion may be the responsible agent for these pathologies. They did not reappear with the intake of another OC containing a lower concentration of ethinyl estradiol (.035 mg instead of .05 mg). This may present some problems in family planning for it is recommended that at least .05 mg of estrogen be incorporated with progesterone in order to have the pill most effective as a contraceptive agent. Examination of the neurologic complications encountered in these 4 patients suggests that intracerebral vascular deficiency has occurred simulating isolated small arterial occlusions.
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PMID:Neuro-ophthalmological complications of contraceptive pills. 1233 85

This report highlights transient Horner's syndrome and trigeminal nerve palsy following labor epidural analgesia. A 29-year-old primigravida had a lumbar epidural catheter placed for analgesia in labor. The analgesia was maintained by infusion of a dilute local anesthetic/opioid mixture and turned off after achieving complete cervical dilation. Approximately 1 hour after delivery she complained of heaviness in her left eyelid, and was noted to have left-sided ptosis and paresthesia within the distribution of the ophthalmic and maxillary divisions of the trigeminal nerve, which resolved over the next 2 hours. There were no other neurologic changes. Horner's syndrome and cranial nerve palsies can occur as a consequence of epidural analgesia for labor.
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PMID:Horner's syndrome and trigeminal nerve palsy after lumbar epidural analgesia for labor and delivery. 1247 90


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