What is Horner's Syndrome?

The so-called Horner syndrom refers to a characteristic group of eye symptoms caused by damage to the autonomic nerve, mainly the sympathetic ganglion of the neck. The disease can occur if any part of the cervical sympathetic pathway is damaged. However, it is extremely rare to have central nervous system disease above the first thoracic spinal cord.

Horner syndrome

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The so-called Horner syndrom refers to a characteristic group of eye symptoms caused by damage to the autonomic nerve, mainly the sympathetic ganglion of the neck. The disease can occur if any part of the cervical sympathetic pathway is damaged. However, it is extremely rare to have central nervous system disease above the first thoracic spinal cord.

TCM disease name

Horner syndrome

English name

Horner syndrom

Common locations

Eye

Common causes

Impaired cervical sympathetic pathway

Common symptoms

Pupils diminish, instantaneous membranes are loose and prominent, eyeballs are sunken, eyelids are drooping

1. Unilateral pupil dilation (pupil shrinkage), drooping eyelids (narrow cleft lip), and invagination are three characteristic symptoms of the disease.

2. Vibration and relaxation of the transient film can be seen. Sometimes half of the eyeball is covered in a fixed position.

3 Eyelid closing ability and pupil's ability to reflect light are still maintained, but corneal dryness may occur if the closing is incomplete.

4 It is difficult to raise the upper eyelid on the affected side and it is difficult to open the eyes. When varus occurs due to drooping eyelids, tears don't stop. Dilation of conjunctival vessels is uncertain.

Neurology refers to: disease side

Often in the afternoon or early morning. Drinking alcohol or nitroglycerin can trigger headache attacks. Headaches are often confined to the same side.

Examination of chest CT to exclude mediastinal lesions

1. Diagnosis can be made according to the three main symptoms of shrinking pupils, drooping eyelids, and invaginations.

2. If the lesion is located in the path from the superior cervical ganglia to the eyeball, the treatment can achieve satisfactory results. At this time, 1-2% epinephrine is given. If dilation is seen, it means that the lesion is located on the path from the superior cervical ganglia to the peripheral nerve (peripheral Horner syndrome).

3 In the case of central Horner syndrome, a small amount of norepinephrine is continuously produced by the remaining postganglionic nerve fibers, and the pupil does not respond to 1 to 2% of adrenaline.

4 The disease needs to be distinguished from irisitis. If it is irisitis, there will be special pain, iris congestion and photophobia. At the same time, it is often accompanied by signs such as pupil shrinkage and anterior chamber flash. Horner's syndrome does not show these symptoms.

1. There is hope for a cure only in peripheral Horner syndrome. Regardless of the treatment method, only 1 to 2% of adrenaline can be administered topically, and the eyes can be administered 3 times a day.

2. Although eyelid drooping, dilated pupils, and transient membrane exacerbations can be quickly alleviated, the sympathetic nerve should be continuously administered within 4 to 5 weeks. If it is caused by trauma, it takes 6 weeks to 3 months to improve symptoms.

Case report of "Honor's syndrome"

Department of Oral Surgery, the Second Affiliated Hospital of Harbin Medical University

Fanner's syndrome is a series of symptoms that appear on the skin, glands, eyes, and accessory organs after the sympathetic stem nerve injury in the neck.

clinical information

Example 1: Zhu, female, aged, found painless mass in the upper right neck for months.

A specialist examination can touch a large lump in the upper part of the right neck, with medium texture, no tenderness, and slight movement. The contents were not extracted through browsing.

A week after admission, the mass was removed under local anesthesia. During the operation, the mass was located in the carotid artery triangle, about the size of a walnut, the surface was smooth, the capsule was intact, and it adhered to the large vessels and nerves. The tumor was completely removed by blunt dissection.

Pathological examination was diagnosed as cervical schwannoma. The wound was healed and discharged after the operation.

After a week, the patient gradually felt the right eye fissure narrowed, the double vision of the eyeball, paroxysmal migraine, and a feeling of soreness in the parotid gland when eating. After reviewing our hospital in the postoperative week, the above symptoms improved significantly. Horner's syndrome was diagnosed after cervical nerve sheath tumor removal.

Example 2: Zhang, female, aged, with painless mass in the back of the neck, a specialist examines the right neck touching an oval mass, about the size of an egg, tough, deep, poor mobility, smooth surface Skin temperature and color are normal.

Can still touch the external carotid artery beat point forward. The contents were not extracted during the puncture and the cervical mass was removed under local anesthesia. During the operation, the mass was located behind the carotid sheath, about the size of an egg, and the surface was smooth and non-adhesive to surrounding blood vessels.

The blunt separation completely removes the mass. "Medical examination" is cervical cavernous hemangioma. On the postoperative day, a right-handed headache occurred, eye fissures narrowed, pupils narrowed, the sides were not large, the eyes were slightly sunken, and the vision was unclear.

Weekly review after surgery, the size of the late hole was large, and the vision was clear. Horner's syndrome was diagnosed after "cervical hemangioma removal".

Example 3: Li, male, aged, has a painless mass in the right neck and grows slowly. Specialist examination of the right neck sternocleidomastoid muscle can touch the large walnut mass, hard, deep, clear boundaries, poor mobility, the carotid artery is moved forward, and palpable palpable. The "B-ultrasound" check was substantial. Under local anesthesia, the mass of the neck was removed. During the operation, the mass was located on the deep side of the anterior fascia behind the arterial sheath. The chicken eggs were large, the surface coating was smooth and intact, and there was adhesion to peripheral blood vessels and nerves. In the deep neck neurovascular anatomy, the cervical sympathetic nerve was cut off by mistake, and after an accidental injury was found, nerve anastomosis was performed. Except for hoarseness, migraine, and no other discomfort after operation, no symptoms of Horner's syndrome were found during a follow-up of six months.

discuss

The cervical sympathetic trunk is located in the common carotid artery, internal carotid artery, vagus nerve, and deep anterior vertebral fascia, and has three sympathetic ganglia: upper, middle, and lower. Peripheral nerves still dominate vascular movement, sympathetic nerves are also distributed in the orbital iris sphincter, mydriatic sphincter, lacrimal gland, and cerebral blood vessels.When the cervical sympathetic nerve is stimulated, it can cause mydriasis, lacrimal gland secretion, and increase the secretion of cerebral glands Vascular constriction, cervical sympathetic nerve syndrome occurs when the cervical sympathetic nerve is blocked or severed. The clinical manifestations are ipsilateral pupil reduction, drooping of the upper eyelid, invagination of the eyeball, and reduction of sweat secretion in the hemilateral side.

When the lateral carotid surgery does not involve the posterior medial side of the carotid sheath, the sympathetic trunk of the neck is generally not damaged, and it is only necessary to pay attention when it reaches this part. Cervical sympathetic nerve injury is the main cause of the disease. Traumatic injuries, surgery, tumors, and inflammatory lesions on the side of the neck often cause the nerve to be involved and cause a series of pathological changes.

The treatment of Horner's syndrome depends on the cause of the disease. As long as it does not hurt the cervical sympathetic stem nerve itself, it will gradually recover its function and the clinical symptoms will gradually disappear. The recovery phenomenon was manifested in that the pupils on both sides were equal in size, and after one month of normal vision, the eyelids were the same width and the pupils were the same. The number of migraines and symptoms improved significantly. It is generally believed that the vast majority can recover within a few months, and those who cannot recover are only a few.

After finding that the cervical sympathetic nerve was accidentally injured during the operation, try to find the stump and perform anastomosis. If possible, nerve transplantation can be used to restore the function.