(105) Horner's Syndrome secondary to a T1 radiculopathy: a case report

Abstract

Horner's Syndrome is typically characterized by the classic triad of miosis (constricted pupil), partial ptosis, and loss of hemifacial sweating (anhidrosis). The most common causes of Horner's Syndrome include brainstem lesions, brachial plexopathies, Pancoast tumors, and other lesion of the primary neurons or postganglionic neurons. Nerve root irritation secondary to lower cervical or upper thoracic radiculopathies normally results in pain, parasthesias, and weakness in specific dermatomal or myotomal patterns depending on the level that is affected; however, the sympathetic nerve fibers are usually not involved. Then again, an inflamed T1 nerve root has the potential to affect some sympathetic fibers since the second-order preganglionic pupillomotor fibers exit the spinal cord at the level of T1 as they enter the cervical sympathetic chain. We present an interesting case of acute cervical and thoracic spine pain followed by upper extremity pain, weakness, parasthesias and visual disturbances in a 46 year-old male. During initial presentation, the patient complained of left sided visual disturbances, miosis of his left pupil, ptosis, neck/upper back pain and little finger weakness/numbness. Due to the suspicion of Horner's Syndrome, the differential diagnoses expanded to include the possibility of Pancoast Tumor and Brachial Plexopathy in addition to radiculopathy. MRI of the brachial plexus and Chest X-Ray did not reveal any signs of tumor. MRI of the cervical spine demonstrated a T1-2 disc extrusion with impingement of the T1 nerve root which was confirmed by EMG/NCS. The patient's Horner's Syndrome, pain and weakness improved after completion of a Medrol Dose Pak and he is currently pending Neurosurgical Evaluation. This case shows the potential of an upper thoracic radiculopathy to manifest sympathetic symptomology of a Horner’s Syndrome along with the classic clinical presentation of pain, parasthesias and weakness.