Horner's Syndrome Flashcards
define horner’s syndrome
a rare neurologic disease that affects the eyes and tissues surrounding from damage to the sympathetic N supply to the face
prevalance horner’s syndrome
1/6000 people
no specific link to age/demographic
correlation between smokers, HS, pancoast tumors
etiology horner’s syndrome
caused by underlying medical issues - disease, tumors, infections, trauma
s/s horner’s syndrome
ispilateral ptosis
miosis
anhidrosis
hyperemia
red eye
iris heterochromia
eye drooping
ptosis
constricted pupils
miosis
what causes ptosis
sympathetic N involvement –> not CN 3
lack of sweating
anhidrosis
unequal pupil sizes, only one eye is constricted
anisocoria
what would high BP indicate with horner’s syndrome
carotid dissection
what would SpO2 indicate in horner’s syndrome
pancoast tumor
what to look at for neuro exam in horner’s syndrome
UMN lesion
CVA
hearing
swallowing
double vision
facial sensation
what CN to assess with horner’s syndrome
2, 3, 4, 5, 6, 8, 9
red flags horner’s syndrome
- pain with ptosis or miosis (raeder paratrigeminal syndrome or a cavernous sinus thrombosis)
- sx with HA “around eyes”
- rapid spike in BP (carotid dissection)
- ptosis with insidious severe U/L HA (intracranial aneurysm)
- hx of smoking or sx of lung CA
causes of 1st order neuron damage (intracranial)
CVA
primary neuron lesion
meninigitis
encephalitis
arnold chiari malformation
MS
intracranial tumors, SC tumors
trauma to spine above T2
causes of 2nd order neuron damage (through thoracic region)
pancoast tumor
subclavian aneursym
brachial plexus trauma
neuroblastoma to sympathetic chain
cervical rib or vertebral fx
mediastinal lymphadenopathy
causes of 3rd order neuron damage (close to major vessels)
internal carotid aneurysm
carotid dissection
herpes zoster infection
temproal arteritis
migraines
carotid cavernous fistula
majority of horner’s syndrome cases are what order neurons
2nd and 3rd
PT POC horner’s syndrome
- ocular exam
- physical and neurological
- eyelid drooping, strengthen affected eye mm, help find ways to do ADLs due to visual deficits
- PT during chemo/radiation
- addressing sx of meningitis/encephalitis
where is a pancoast tumor located
above 1st rib
dx/tests for horner’s syndrome
- 10% cocaine eye drop test - induce pupil dilation by preventing norepinephrine reuptake (anisicoria and degree of dilation is evaluated)
- hydroxy amphetamine eye drop test - causes release of norepinephrine (if both pupils dilate = 1st or 2nd order neuron, if smaller one fails to dilate = 3rd order neuron)
- pupil comparisons - interpaleprabal fissure
- MRI (back and neck)
- CT scans
- chest x-ray for pancoast tumor
tx horner’s syndrome
no specific tx
have to tx underlying condition
