Horner's syndrome: roentgen manifestations.

Abstract

Hare (1) in 1838 and Horner (2) in 1869 described the group of clinical symptoms now known as Horner's syndrome. It consists of miosis, ptosis of the upper lid, enophthalmos, dryness of the skin of the face, and vascular hyperemia. In progressive cases, paresthesia of the arm follows, succeeded in turn by muscular atrophy. All symptoms are ipsilateral. This syndrome is produced by damage to the cervical sympathetic or to part, or all, of its ganglia at the eighth cervical or the first two thoracic levels, the severity of the manifestations depending on the extent of the lesion. The same symptoms may be the result of damage to the ciliospinal center of the spinal cord at the appropriate levels or to the roots extending from those parts of the cord. Causative lesions include neoplastic invasion of the nerve sheaths or walls of the arteries and secondary degenerative changes produced by pressure. The etiologic factors in the development of Horner's syndrome and the clinical data may be summarized as follows: Horner's Syndrome: Clinical and Etiologic Factors I. Symptoms (all ipsilateral) 1. Miosis, paralysis of the dilator pupillae 2. Ptosis of the upper lid, paralysis of the tarsal muscle 3. Enophthalmos, paralysis of the orbital muscle (Müller) 4. Anhidrosis of the skin of the face 5. Vascular hyperemia of the face 6. Paresthesia of the arm followed by muscular atrophy (Klumpke syndrome) II. Pathology 1. Damage to the cervical sympathetic or part or all of its ganglia, at the level of C-8, D-l, and D-2 2. Damage to the ciliospinal center of the spinal cord at the same level 3. Damage to roots above mentioned neurons and their communicating branches III. Causes (producing pressure and degeneration or direct invasion and destruction of the neurons)* 1. Congenital Status dysraphicus, cervical rib, congenital spine deformities (r.d.) 2. Inflammatory: Herpes zoster (c,d.) Tuberculosis, osseous or glandular, level of C-8, D-l, and D-2 (r.d.) Syphilis: aneurysm (c.d. and r.d.) Epidemic meningitis (c.d;) Encephalitis (c.d.) Anterior poliomyelitis (c.d.) 3. Traumatic Postoperative complications, pneumolysis, gun and knife wounds, thoracotomies, paravertebral block, phrenicotomy, hematomyelia; level of C-8, D-l, and D-2 (c.d. and r.d.) 4. Degenerative Bulbar palsy, syringomyelia (c.d.), scleroderma (Bing, ) (c.d.) 5. Neoplastic Lymphosarcoma, Hodgkin's disease (c.d. and r.d.) Neurofibrosarcoma, epipharyngeal carcinoma (Bremer) (c.d. and r.d.) Thymoma, struma maligna (c.d. and r.d.) Bronchogenic carcinoma with soft-tissue metastases at level of C-8, D-l, D-2 (no bone destruction) (c.d. and r.d.) Pancoast tumor, with bone destruction (r.d. and c.d.) Metastases to soft tissues and bone from distant neoplasms (r.d. and c.d.) Tumor of the gasserian ganglion (c.d.) Of the congenital conditions which may produce Horner's syndrome special mention may be made of “status dysraphicus.”