Horner's Syndrome

Question 1

define horner’s syndrome

Answer 1

a rare neurologic disease that affects the eyes and tissues surrounding from damage to the sympathetic N supply to the face

Question 2

prevalance horner’s syndrome

Answer 2

1/6000 people
no specific link to age/demographic
correlation between smokers, HS, pancoast tumors

Question 3

etiology horner’s syndrome

Answer 3

caused by underlying medical issues - disease, tumors, infections, trauma

Question 4

s/s horner’s syndrome

Answer 4

ispilateral ptosis
miosis
anhidrosis
hyperemia
red eye
iris heterochromia

Question 5

eye drooping

Answer 5

ptosis

Question 6

constricted pupils

Answer 6

miosis

Question 7

what causes ptosis

Answer 7

sympathetic N involvement –> not CN 3

Question 8

lack of sweating

Answer 8

anhidrosis

Question 9

unequal pupil sizes, only one eye is constricted

Answer 9

anisocoria

Question 10

what would high BP indicate with horner’s syndrome

Answer 10

carotid dissection

Question 11

what would SpO2 indicate in horner’s syndrome

Answer 11

pancoast tumor

Question 12

what to look at for neuro exam in horner’s syndrome

Answer 12

UMN lesion
CVA
hearing
swallowing
double vision
facial sensation

Question 13

what CN to assess with horner’s syndrome

Answer 13

2, 3, 4, 5, 6, 8, 9

Question 14

red flags horner’s syndrome

Answer 14

• 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

Question 15

causes of 1st order neuron damage (intracranial)

Answer 15

CVA
primary neuron lesion
meninigitis
encephalitis
arnold chiari malformation
MS
intracranial tumors, SC tumors
trauma to spine above T2

Question 16

causes of 2nd order neuron damage (through thoracic region)

Answer 16

pancoast tumor
subclavian aneursym
brachial plexus trauma
neuroblastoma to sympathetic chain
cervical rib or vertebral fx
mediastinal lymphadenopathy

Question 17

causes of 3rd order neuron damage (close to major vessels)

Answer 17

internal carotid aneurysm
carotid dissection
herpes zoster infection
temproal arteritis
migraines
carotid cavernous fistula

Question 18

majority of horner’s syndrome cases are what order neurons

Answer 18

2nd and 3rd

Question 19

PT POC horner’s syndrome

Answer 19

• 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

Question 20

where is a pancoast tumor located

Answer 20

above 1st rib

Question 21

dx/tests for horner’s syndrome

Answer 21

• 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

Question 22

tx horner’s syndrome

Answer 22

no specific tx
have to tx underlying condition