- Sachin Kedar, MD
Sachin Kedar, MD
- Associate Professor of Neurology and Ophthalmology
- University of Nebraska Medical Center and Truhlsen Eye Institute
- Valérie Biousse, MD
Valérie Biousse, MD
- Cyrus H. Stoner Professor of Ophthalmology
- Professor of Ophthalmology and Neurology
- Emory University
- Nancy J Newman, MD
Nancy J Newman, MD
- Leo Delle Jolley Professor of Ophthalmology
- Emory University
Horner syndrome is a classic neurologic syndrome whose signs include miosis, ptosis, and anhidrosis. Also called oculosympathetic paresis, a Horner syndrome can be produced by a lesion anywhere along the sympathetic pathway that supplies the head, eye, and neck. Causes range from benign to serious, requiring a methodological approach to diagnostic evaluation. The differential diagnosis also differs in children and adults, leading to differences in the diagnostic approach.
Horner syndrome can result from a lesion anywhere along a three-neuron sympathetic (adrenergic) pathway that originates in the hypothalamus (figure 1):
●The first-order neuron descends caudally from the hypothalamus to the first synapse, which is located in the cervical spinal cord (levels C8-T2, also called ciliospinal center of Budge).
●The second-order neuron travels from the sympathetic trunk, through the brachial plexus, over the lung apex. It then ascends to the superior cervical ganglion, located near the angle of the mandible and the bifurcation of the common carotid artery.
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Jul 14, 2015.References
- Kardon, R. Anatomy and physiology of the autonomic nervous system.. In: Walsh and Hoyt Clinical Neuro-ophthalmology, 6th, Miller, NR, Newman, NJ, Biousse, V, Kerrison, JB (Eds), Williams & Wilkins, Baltimore 2005. p.649.
- Pilley SF, Thompson HS. Pupillary "dilatation lag" in Horner's syndrome. Br J Ophthalmol 1975; 59:731.
- Salvesen R. Innervation of sweat glands in the forehead. A study in patients with Horner's syndrome. J Neurol Sci 2001; 183:39.
- Morrison DA, Bibby K, Woodruff G. The "harlequin" sign and congenital Horner's syndrome. J Neurol Neurosurg Psychiatry 1997; 62:626.
- Walton KA, Buono LM. Horner syndrome. Curr Opin Ophthalmol 2003; 14:357.
- Maloney WF, Younge BR, Moyer NJ. Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. Am J Ophthalmol 1980; 90:394.
- Edwards A, Andrews R. A case of Brown-Sequard syndrome with associated Horner's syndrome after blunt injury to the cervical spine. Emerg Med J 2001; 18:512.
- Pancoast, HK. Superior pulmonary sulcus tumor: Tumor characterized by pain, Horner's syndrome, destruction of bone and atrophy of hand muscles. JAMA 1932; 99:1391.
- Biousse V, Guevara RA, Newman NJ. Transient Horner's syndrome after lumbar epidural anesthesia. Neurology 1998; 51:1473.
- Perry C, James D, Wixon C, et al. Horner's syndrome after carotid endarterectomy--a case report. Vasc Surg 2001; 35:325.
- Ettinger ER, Wyatt HJ, London R. Anisocoria. Variation and clinical observation with different conditions of illumination and accommodation. Invest Ophthalmol Vis Sci 1991; 32:501.
- Furlan JC, Sundaram AN. Sudden-onset anisocoria in a patient with upper respiratory tract infection. CMAJ 2014; 186:57.
- Biousse V, Touboul PJ, D'Anglejan-Chatillon J, et al. Ophthalmologic manifestations of internal carotid artery dissection. Am J Ophthalmol 1998; 126:565.
- Selim M, Caplan LR. Carotid Artery Dissection. Curr Treat Options Cardiovasc Med 2004; 6:249.
- Lyrer PA, Brandt T, Metso TM, et al. Clinical import of Horner syndrome in internal carotid and vertebral artery dissection. Neurology 2014; 82:1653.
- de Bray JM, Baumgartner R, Guillon B, et al. Isolated Horner's syndrome may herald stroke. Cerebrovasc Dis 2005; 19:274.
- Biousse V, D'Anglejan-Chatillon J, Touboul PJ, et al. Time course of symptoms in extracranial carotid artery dissections. A series of 80 patients. Stroke 1995; 26:235.
- Fujisawa H, Marukawa K, Kida S, et al. Abducens nerve palsy and ipsilateral Horner syndrome: a predicting sign of intracranial carotid injury in a head trauma patient. J Trauma 2001; 50:554.
- Havelius U. A Horner-like syndrome and cluster headache. What comes first? Acta Ophthalmol Scand 2001; 79:374.
- Manzoni GC, Terzano MG, Bono G, et al. Cluster headache--clinical findings in 180 patients. Cephalalgia 1983; 3:21.
- Jeffery AR, Ellis FJ, Repka MX, Buncic JR. Pediatric Horner syndrome. J AAPOS 1998; 2:159.
- Ogita S, Tokiwa K, Takahashi T, et al. Congenital cervical neuroblastoma associated with Horner syndrome. J Pediatr Surg 1988; 23:991.
- Woodruff G, Buncic JR, Morin JD. Horner's syndrome in children. J Pediatr Ophthalmol Strabismus 1988; 25:40.
- George ND, Gonzalez G, Hoyt CS. Does Horner's syndrome in infancy require investigation? Br J Ophthalmol 1998; 82:51.
- Musarella MA, Chan HS, DeBoer G, Gallie BL. Ocular involvement in neuroblastoma: prognostic implications. Ophthalmology 1984; 91:936.
- Johnston JA, Parkinson D. Intracranial sympathetic pathways associated with the sixth cranial nerve. J Neurosurg 1974; 40:236.
- Kardon RH, Denison CE, Brown CK, Thompson HS. Critical evaluation of the cocaine test in the diagnosis of Horner's syndrome. Arch Ophthalmol 1990; 108:384.
- Thompson BM, Corbett JJ, Kline LB, Thompson HS. Pseudo-Horner's syndrome. Arch Neurol 1982; 39:108.
- Morales J, Brown SM, Abdul-Rahim AS, Crosson CE. Ocular effects of apraclonidine in Horner syndrome. Arch Ophthalmol 2000; 118:951.
- Koc F, Kavuncu S, Kansu T, et al. The sensitivity and specificity of 0.5% apraclonidine in the diagnosis of oculosympathetic paresis. Br J Ophthalmol 2005; 89:1442.
- Chen PL, Chen JT, Lu DW, et al. Comparing efficacies of 0.5% apraclonidine with 4% cocaine in the diagnosis of horner syndrome in pediatric patients. J Ocul Pharmacol Ther 2006; 22:182.
- Packer AJ, Bienfang DC. Aberrant regeneration involving the oculomotor and abducens nerves. Ophthalmologica 1984; 189:80.
- Cremer SA, Thompson HS, Digre KB, Kardon RH. Hydroxyamphetamine mydriasis in normal subjects. Am J Ophthalmol 1990; 110:66.
- Wilhelm H, Ochsner H, Kopycziok E, et al. Horner's syndrome: a retrospective analysis of 90 cases and recommendations for clinical handling. Ger J Ophthalmol 1992; 1:96.
- Bates AT, Chamberlain S, Champion M, et al. Pholedrine: a substitute for hydroxyamphetamine as a diagnostic eyedrop test in Horner's syndrome. J Neurol Neurosurg Psychiatry 1995; 58:215.
- Wilhelm H. Neuro-ophthalmology of pupillary function--practical guidelines. J Neurol 1998; 245:573.
- Gelal FM, Kitis O, Calli C, et al. Craniocervical artery dissection: diagnosis and follow-up with MR imaging and MR angiography. Med Sci Monit 2004; 10:MT109.
- Digre KB, Smoker WR, Johnston P, et al. Selective MR imaging approach for evaluation of patients with Horner's syndrome. AJNR Am J Neuroradiol 1992; 13:223.