Horner's syndrome, also known as cervical sympathetic syndrome, is a syndrome caused by any compression and destruction of the pathway from the sympathetic nerve center to the eyes, resulting in pupil contraction, enophthalmos, ptosis and anhidrosis of the affected side. According to the damaged parts, it can be divided into central disorder, pre-holiday disorder and post-holiday disorder.

Clinical manifestations are:

1. Pupil contraction: it is the main sign of Horner's syndrome. Due to the paralysis of the dilator on the affected side, the pupils on both sides are unequal, especially in dark or bright places. This is because the sphincter of the pupil is not paralyzed, so the pupils on both sides of the language are contracted and difficult to identify.

2. Small ptosis: it is an important symptom of Horner syndrome, second only to mydriasis. Early eyelid fission is small and obvious. It is caused by palpebral paralysis and slight ptosis of the upper eyelid. At this time, the lower eyelid may also be slightly enlarged. By comparing with the contralateral ptosis, we can know the ptosis. It can also be determined by observing the degree to which the upper edge of cornea is covered. Determining whether the lower eyelid is elevated can guide the patient to stare upward, and the scleral band under Horner syndrome is narrow.

3. Retraction of eyeball: It is often considered as one of the three symptoms of Horner syndrome, which may be related to orbital muscle paralysis. However, as mentioned above, the human orbital muscles are degenerating, and the effect is weak, so the eyeball recession is an illusion caused by the narrow eyelid fission, not a real recession, which can be confirmed when measuring the eyeball position.

4. The ipsilateral cutaneous vasodilation (facial flushing) and anhidrosis: The sympathetic nerve fibers distributed in facial cutaneous blood vessels and sweat glands are basically similar to those controlling pupil dilators, passing through the cervical sympathetic trunk and superior cervical ganglion. However, some people think that their paths to the end in the brain stem and spinal cord are not exactly the same, so they may have dissociative symptoms, that is, pupil constriction, but they will not have facial flushing and anhidrosis.

5. In addition to eye signs, patients are often accompanied by symptoms of cervical spondylosis and autonomic nervous dysfunction. Such as headache, dizziness, neck pain, palpitation and arrhythmia.

Extended data:

Etiology of Horner syndrome

1. The most common cause of Horner syndrome is carotid dissection, which can be spontaneous or caused by local neck trauma. Spinal massage is an independent risk factor for internal carotid artery dissection, and the stroke caused by it is also a controversial topic.

At present, there have been many reports of Horner syndrome caused by ICA interlayer caused by spinal massage. In this case, ICA interlayer is not considered; Because the patient has obvious radiation brachial plexus neuralgia at the same time, and CT angiography of the neck excludes the possibility of dissection. ?

2. Facial anhidrosis is a sign of T 1 nerve root injury or sympathetic nerve injury before the festival. Because the sweating nerve fiber is separated from the carotid plexus at the level of carotid bifurcation, it exists in the spinal cord at T2-T3 level. Therefore, it is necessary to pay attention to the rare partial Horner syndrome caused by T 1 nerve root level lesions. ?

3. Horner's syndrome coexists with symptoms such as pain and weakness in the ipsilateral upper limb, which accords with the diagnostic criteria of superior sulcus tumor syndrome, suggesting that malignant tumors at the apex of the lung may involve sympathetic trunk and inferior brachial plexus at the same time.

However, lung X-ray examination ruled out lung lesions. The following electrophysiological examination showed that the juice of the medial forearm cutaneous nerve was normal, which was consistent with the pre-holiday nerve root lesion, and the nuclear magnetic resonance also confirmed this. If the tumor in the superior sulcus of lung involves the lower trunk of brachial plexus, SAP should be weakened or disappeared. ?

Pupil drug test can be used to confirm whether Horner's syndrome occurs or not, which is helpful to locate the lesions on the sympathetic nerve pathway of the eye. Cocaine is a norepinephrine reuptake inhibitor. If it is used in patients who have lost sympathetic innervation of iris major muscle, it will not induce pupil dilation, which proves that Horner syndrome does exist. ?

4. On the other hand, local injection of hydroxylamine can lead to pupil dilation by promoting the release of adrenaline from presynaptic nerve endings. This reaction only occurs when the postganglionic neurons (third-order neurons) are intact, so it can be used to distinguish central, preganglionic and postganglionic lesions.

5. Central Horner syndrome is caused by brain stem stroke, such as Vallenborg syndrome. It is rarely confused with peripheral causes because it is often combined with other manifestations that can be suggested as brain stem injury, including nystagmus, dissociative sensory disturbance and ipsilateral cerebellar symptoms.

Baidu Encyclopedia-Horner Syndrome