Ipsilateral Ptosis Research Articles

An Unusual Paediatric Neck Mass: Cervical Lipoblastoma with Spinal Involvement.

Lipoblastoma is a benign tumour derived from embryonic white fat and is more commonly seen in children. Spinal involvement is rare, with only 14 cases reported to date. We report a case of a 7-year-old boy who was presented with an asymptomatic right neck swelling for 5 years. Clinical examination revealed a soft multilobulated mass causing tracheal deviation with normal neurological examination. Ultrasound, Computed tomography and Magnetic resonance imaging showed a lipomatous lesion with extension to spinal foramina at C3-C5 causing displacement of the spinal cord. Near total excision of the tumour was done with a small remnant left behind at C3-C4 as it was tightly adhered to the vertebral artery. Histopathological samples were consistent with lipoblastoma. The patient developed ipsilateral ptosis and pupillary myosis which improved on the second-month postoperative review; no other neurological deficit was noted, and a follow-up cervical MRI showed no recurrence.

Isolated ipsilateral ptosis associated with ventral midbrain infarction: a case report and literature review.

Documented cases of ipsilateral ptosis caused by midbrain infarction remain rare. Herein, we present a patient with isolated ipsilateral ptosis that was initially considered to be a consequence of myasthenia gravis but was subsequently attributed to ventral midbrain infarction. We also discuss the possible underlying mechanisms; ipsilateral ptosis in our patient was attributed to selective damage of the levator palpebral muscle branch of the oculomotor nerve. The patient was started on aspirin (200 mg once daily) and atorvastatin (40 mg once daily). Improvement in ptosis occurred from day 5 of admission, and the patient was subsequently discharged. Ptosis disappeared 1 month after onset. This report describes an extremely rare case of ventral midbrain infarction presenting with isolated ipsilateral ptosis. Careful examination, including magnetic resonance imaging, is essential in such patients, especially in those with multiple cerebrovascular risk factors.

Tube Thoracostomy Associated Horner Syndrome: A Case Report

Horner Syndrome is a clinical syndrome caused by disruption of the sympathetic pathway, typically characterized by ipsilateral ptosis, miosis, and facial anhidrosis. Complications can arise during interventional procedures in the thoracic region due to proximity to the upper preganglionic nerve. A 21-year-old female patient who developed drooping of the right eyelid and Horner's syndrome following tube thoracostomy procedure is presented here. It is important to keep in mind that the tube has been removed and the condition may be reversible in terms of treatment.

A Rare Case of Horner's Syndrome after Neck Dissection Operation

The classic triad of ipsilateral palpebral ptosis, pupillary miosis, and facial anhidrosis defines Horner's syndrome, which results from cervical sympathetic chain damage. This is an uncommon complication of neck surgery like thyroidectomy and neck dissection. A fifty-two-year-old male patient presented with papillary thyroid carcinoma with lymph nodes metastases, underwent total thyroidectomy with central and left lateral modified radical neck dissection. One day after the operation, the patient presented with signs of Horner's syndrome.

PANCOAST TUMOR PRESENTING WITH HORNER SYNDROME: A CASE REPORT

Case Report: A 50-year-old man was referred to Dr. Moewardi General Hospital with history of right chest pain that radiate to the right back and hand for 2 months. His complaint did not improve with medication and physical therapy. On physical examination we observed multiple nodules on the right axilla, scapula, and colli region. Neurological examination revealed right sided partial ptosis, anisocoria, ipsilateral weakness, and ipsilateral allodynia, and anhidrosis T1 dermatome. CT-scan showed a right lung mass in the superior lobe of the apical segment. The diagnosis of Horner syndrome is then established caused by multiple lymphadenopathies. His symptoms then relieved after lymphadenectomy. Conclusion: Horner syndrome, characterized by ipsilateral pupillary anisocoria, ptosis and anhidrosis, is one of the complications of Pancoast tumor invasion to the sympathetic nervous system in the C8, T1, and T2 nerve territory.

Analysis of anatomy of head and neck: A study through empiricals part- II

In this study we introduce new hypothesis into the anatomical-structure, the head, and neck, neuro-embryology, the nerves and muscles, followed by the physiologic-variants, operational / surgical implications and considerations and then lastly clinical significancy of the study. The wound/damage to the cervical altruistic ganglia can elicit the syndrome-of-Horner, which is ipsilateral ptosis, miosis, and also facial scrub—anhidrosis. The torticollis-transpires as sterno-cleido-mastoid (SCM) muscle-tone abbreviates spasmodically, generating the fluctuating of the neck opposite to aomolous muscle-tome cross or control leads to in biotic if the sterno-cleido-mastoid is incapacitated, also that might be leading to fibrosis as well as margarine of ‘muscle-fiberes’. And as well turn out as a consequence of enhanced muscle - tone, and/or dystonia muscle spasms and spams, lessening from the poignant and sensitive nervousness stress and strain and tension also, and/or unanticipated behaviors. Though, even though, whilst evaluating the traumatic injuries or wounds, it is so crucial to omit or inhibit certain carotid monitorings as well as distinguishing in the interior of the neck.

Recurrent Painful Ophthalmoplegic Neuropathy Mistaken for Oculomotor Schwannoma: A Case Report

AbstractRecurrent painful ophthalmoplegic neuropathy (RPON) is a headache disorder classified as a cranial neuropathy. It is characterized by episodes of unilateral headache followed by ipsilateral ophthalmoplegia due to ocular cranial nerve palsy. Symptoms usually subside spontaneously within weeks to months. RPON commonly occurs in childhood, though it is overlooked at times as a possible differential diagnosis. The pathophysiology of RPON is not entirely clear. Typical magnetic resonance imaging (MRI) findings in children include nerve thickening and gadolinium enhancement. However, these findings are not specific to this condition. Nerve thickening in RPON can resemble schwannomas, thereby causing a diagnostic dilemma. Here, we present a 13-year-old boy with a history of unilateral headaches associated with ipsilateral ptosis and diplopia. The first MRI indicated thickening and gadolinium enhancement of the right oculomotor nerve, which was interpreted as a schwannoma. However, his symptoms resolved after a few weeks and the follow-up MRI showed resolution of nerve changes. This clinical presentation was consistent with RPON. This case demonstrates the need for a careful follow-up of RPON patients.

Cortico-hypothalamic pathway of Horner syndrome derived from isolated lenticulostriate stroke.

Horner syndrome presents with ipsilateral ptosis, miosis, and anhidrosis due to interruption of the oculosympathetic pathway. Patients with acute ischemic stroke may present with Horner syndrome, which may help locate the lesion. However, the underlying pathways involved in Horner syndrome caused by isolated lenticulostriate ischemic stroke remain unclear. We screened consecutive patients with acute ischemic stroke admitted to the Second Affiliated Hospital of Guangzhou Medical University from 1 January 2020 to 31 December 2021, and searched for cases of isolated lenticulostriate strokes presenting with Horner syndrome. Strokes involving the brainstem or hypothalamus, or those caused by carotid dissection or carotid cavernous fistula were excluded based on neuroimaging and cerebrovascular examination. Among the 1706 acute stroke patients, three patients developed temporary or long-term Horner syndrome due to an ipsilateral lenticulostriate ischemic lesion. Diffusion-tensor imaging revealed disruption of an uncrossed pathway from Brodmann areas 3, 1, and 2 through the basal ganglia to the ipsilateral hypothalamus. These findings suggest that Horner syndrome may be due to a disruption of an uncrossed cortico-basal ganglia-hypothalamic sympathetic pathway.

Delayed Horner's Syndrome After Multiple Penetrating Stab Injury of the Neck.

Horner's syndrome is characterized by a triad of symptoms (ipsilateral miosis, ptosis, and anhidrosis) with damage of the sympathetic nervous system. The condition may be congenital or acquired from traumatic conditions including cardiovascular surgery. Horner's syndrome can be also caused by neck trauma especially when cervical vital structures such as blood vessels, the aerodigestive tract, and nerves are disrupted. This report describes a 16-year-old woman with delayed Horner's syndrome who initially presented with internal jugular vein injury caused by multiple penetrating stab injury to the neck. To the best of our knowledge, this is the first reported case of Horner's syndrome resulting from neck trauma of which symptoms were presented after a couple of weeks after initial trauma. Understanding this rare clinical course may help surgeons pay attention to not only early hospital course but also long-term complications of patients with neck trauma.

Unilateral advanced glaucoma in isolated congenital ectropion uveae with ipsilateral ptosis: A pictorial description of five children.

Aim: To report the cases of five children with unilateral advanced glaucoma in isolated congenital ectropion uveae (CEU) with ipsilateral ptosis and myopia. Methods: This is an ambispective observational case series. After diagnosing one patient with CEU and glaucoma, consecutive patients presenting with unilateral ptosis, congenital iris anomaly, and glaucoma between 2014 to 2020, and had completed a minimum one-year postoperative follow-up, were analyzed. Results: Of the 1421 newly registered pediatric glaucoma patients in the period under review, five children were diagnosed with CEU. All patients presented with gradual painless diminution of vision in the left eye in early adolescence. The left eye of all patients had peculiar clinical features: mild congenital ptosis, high iris insertion, crypt-less smooth iris surface, congenital ectropion uveae, pigments over anterior lens capsule, high myopia, advanced glaucomatous optic disc cupping, and very high intraocular pressure (IOP), which was > 45 mmHg in all cases. The right eye showed signs of angle dysgenesis with mild anterior iris insertion and numerous fine iris processes. Antiglaucoma medications and angle surgery failed to control the IOP, and all children required glaucoma filtration surgery, resulting in reasonable IOP control. Despite the older age, postoperative strict amblyopia treatment resulted in significant improvement in vision.Conclusions: Although ectropion uveae and ptosis have been present since birth, unilaterality, and the asymptomatic nature of the disease led to the late presentation with irreversible damage. Early surgical management and amblyopia therapy are the cornerstones of management.Abbreviations: CEU = Congenital ectropion uvea, CIES = Congenital Iris Ectropion Syndrome, ASD = Anterior segment dysgenesis syndrome, BCVA = Best-corrected visual acuity, IOP = Intraocular pressure

Eyebrow Position Before and After Enucleation

The presence of eyebrow elevation in anophthalmic patients has been used as evidence to support a proprioceptive stimulus for frontalis innervation. In this study, we examined the frequency of brow elevation before and after enucleation and reviewed additional clinical findings to determine if any were associated with eyebrow position. A retrospective study was performed on 134 anophthalmic patients. Demographics, measurements, and photographs were reviewed. Reference photographs were used to subjectively grade brow position and sulcus depth. Preoperative eyebrow elevation was present in 56.2% of patients without blepharospasm from a painful eye, of who 62% had chronic visual loss. Ipsilateral ptosis (p = 0.008), deep superior sulcus (p < 0.001), and right-sided pathology (p = 0.045) were more common in patients with brow elevation. Symmetrically elevated brows were more frequent before right than left enucleation (p = 0.05). Brow position remained stable after 61.9% of procedures. While often mild, postoperative brow elevation was seen in 31.0% of patients without preoperative elevation. Deepening of the superior sulcus was more common in patients with new relative brow elevation (p = 0.031). Anophthalmic ptosis and right-left surgical side were not associated with new postoperative brow elevation. Eyebrow elevation was often present prior to enucleation and associated with an increased occurrence of ptosis, superior sulcus deepening, and right-sided pathology. Intact vision was not needed to maintain an elevated brow. Superior sulcus deepening, but not ptosis, was more common in patients developing new postoperative brow elevation. The findings support both proprioceptive and compensatory mechanisms for eyebrow elevation.

Paratrigeminal Neuralgia that Improved with Treatment of Hypertension in a Patient with Raeder’s Syndrome After Carotid Artery Stenting

BACKGROUND: Although there have been reports of Raeder’s syndrome developing after carotid artery dissection, to our knowledge, no case of Raeder’s syndrome occurring after carotid stenting has been reported. CASE REPORT: A 46-year-old man was urgently treated with a self-expanding stent for idiopathic right carotid artery dissection. However, the patient complained of moderate oppressive pain in the right orbit and forehead immediately after stent placement. Further examination revealed a right eye miosis and right ptosis. No anhidrosis was noted. A diagnosis of Raeder’s syndrome was made based on partial Horner’s syndrome and pain in the first branch of the trigeminal nerve. We noticed that he had hypertension and started antihypertensive medication. After starting the antihypertensive medication, his blood pressure stabilized, and his periorbital pain disappeared dramatically as his blood pressure fell. However, Horner’s symptoms (miosis and ipsilateral ptosis) were still present. CONCLUSION: We experienced a case of Raeder’s syndrome that occurred after stenting of the carotid artery. Neuralgia improved by treatment of hypertension. It should be noted that the paratrigeminal neuralgia of Raeder’s syndrome after carotid stenting can be caused by hypertension. KEY WORDS: Antihypertensive medication, Horner’s symptoms, Raeder’s syndrome, stenting of the carotid artery

Hornerandrsquo;s Syndrome due to a Spontaneous Internal Carotid Artery Dissection treated with Casper Stent

Horner syndrome is a constellation of neurological findings consisting of ipsilateral ptosis, miosis and anhidrosis. Partial Horner syndrome, comprising ipsilateral ptosis and miosis in the absence of anhidrosis, is a well-documented but uncommon manifestation of internal carotid artery dissection. Internal carotid artery dissection (ICAD) is a rare entity that either results from traumatic injury or can be spontaneously preceded or not by aminor trauma such as sporting activities, is a common cause of ischaemic stroke in young patients. As many as 40 to 50% of patients with carotid dissection will develop an ipsilateral Horner’s sindrome.

WITHDRAWN: HORNER’S SYNDROME DURING HIGH-INTENSITY FOCUSED ULTRASOUND ABLATION FOR A BENIGN THYROID NODULE.

Abstract Objective Horner’s syndrome (HS) is a rare complication of high-intensity focused ultrasound (HIFU) and radiofrequency ablation for thyroid nodules. We present such a case and discuss how to avoid this complication in the future. Methods This case occurred during HIFU treatment of a benign thyroid nodule (BTN). Ultrasound and fine-needle aspiration cytology (FNAC) were performed before the procedure. Volume reduction was evaluated at 6 weeks, 3, 6, and 12 months. Technical success was ≥50% reduction at 6 months. Results A 30-year-old woman presented with a solitary symptomatic thyroid nodule. Her thyroid stimulating hormone was 1.16 (ref 0.4-3.6) μUI/mL), ultrasound found a 13 mL right-thyroid EU-TIRADS 4 nodule. Two FNACs were read as Bethesda II. The subsequent HIFU procedure was conducted with local 2% lidocaine anesthesia. The procedure was painful (visual analogic scale 10/10) and ipsilateral partial ptosis occurred during the procedure. Volume reduction at 12 months was 34.6% of the initial volume with persisting functional and cosmetic complaints, discomfort, and partial ptosis. As the volume reduction was ≤50%, the procedure was a technical failure. A new FNAC was read as Bethesda IV. A right lobectomy was performed without postoperative outcomes and without requiring hormonal replacement therapy. Pathological evaluation found no malignant cells. Conclusion HS is a rare complication of HIFU for management of BTNs. It may be symptomatic and have sequalae that persist for months. Severe neck pain may by associated, but further investigation is needed.

Post-Traumatic Weber’s Syndrome: a Rare Presentation

Weber’s syndrome is a midbrain lesion characterized by ipsilateral oculomotor nerve palsy with contralateral hemiparesis or hemiplegia, commonly due to vascular infarct involving paramedian branches of posterior cerebral artery or basilar bifurcation perforating branches. In this case report, we have discussed about a young man who presented with penetrating injury by valve of tyre tube to the right nostril following which he had right side epistaxis with ipsilateral ophthalmoplegia and ptosis with contralateral hemiparesis. Computed tomography evaluation showed presence of sphenoidal bony fragment impinging the midbrain. Patient was managed conservatively. To our best knowledge, traumatic Weber’s syndrome is very rare.

Horner’s Syndrome Following Obstetric Neuraxial Blockade: A Systematic Review of the Literature

(Int J Obstet Anesth. 2018;35:75–87) Horner syndrome (HS), characterized by ipsilateral miosis, ptosis and anhydrosis, has been reported following regional anesthetic techniques such as cervical and brachial plexus blocks and epidural anesthetics. Although rare, HS has been reported in women who underwent obstetric neuraxial blockade (NB). The current authors undertook a systematic review of the literature that reported HS after obstetric NB in order to better inform anesthesiologists regarding the course and management of this condition.

Post-operative nerve injuries after cervical spine surgery.

Although relatively rare, post-operative nerve injuries may occur after cervical spine procedures. The most common post-operative neural disorder is C5 nerve palsy. The risk factors for C5 nerve palsy are male gender, OPLL, and posterior cervical approaches. It generally presents with deltoid and/or biceps weakness, and may present immediately or several days after surgery. Treatment is generally conservative due to transient duration of symptoms, but evaluation of residual compression at C4-5 is essential. PTS (Parsonage-Turner syndrome) is an idiopathic plexopathy generally presenting with severe neuropathic pain in the shoulder, neck, and arms, followed by neurological deficits involving the upper brachial plexus. The deficits typically present in a delayed fashion after the onset of pain. Once residual nerve compression is ruled out, initial treatment is based on pain control and physical therapy. Post-operative C8-T1 nerve palsies occur with weakness of the five intrinsic muscles of the hand innervated by the medial nerve, with sensory symptoms in the territory innervated by the ulnar nerve (ulnar two digits of the hand), and also the medial forearm. The risk factors for C8-T1 nerve injuries after surgery are C7 pedicle subtraction osteotomies and posterior fixation of the cervico-thoracic junction, especially in patients with preoperative C7-T1 stenosis. A wide foraminal decompression at C7-T1 region is necessary to minimize risk of this complication. Finally, Horner's syndrome can occur post-operatively, especially after anterolateral approaches to the middle and lower levels of the cervical spine. It is characterized by ipsilateral papillary miosis, facial anhydrosis, and ptosis secondary to injury of the cervical sympathetic nerves. Avoid using the cautery on the lateral border of the longus colli muscle, where the sympathetic chain lies and place the retractors properly underneath the muscle to decrease the chance of sympathetic injuries. It can also occur from iatrogenic compression or injury to the T1 nerve root, as the sympathetic chain gets some of its fibers from that level. Understanding the most common potential nerve injuries after cervical spine procedures is helpful in prevention, early diagnosis, and appropriate management.

Transarterial embolization of carvernous sinus dural arteriovenous fistulas of slender feeding artery with rapid injection of Onyx

Objective To observe the efficacy of transarterial embolization of carvernous sinus dural arteriovenous fistulas (CSDAVFs) with slender feeding artery by rapid injection of Onyx. Methods From December 2010 to December 2016, a total of 20 patients with CSDAVFs with slender feeding artery were admitted to the Neurosurgery Department of the First Affiliated Hospital of Soochow University (12 cases), Changhai Hospital of the Second Military Medical University (4 cases) and the Second Affiliated Hospital of Medical College, Zhejiang University (4 cases). Those clinical data were analyzed retrospectively in this study. All underwent transarterial embolization with rapid injection of Onyx. Results Twenty-two interventional therapeutic procedures and embolization of feeding arteries were performed in all 20 patients, which involved ascending pharyngeal arteries in 11, middle meningeal arteries in 7, accessory meningeal arteries in 2 and internal maxillary arteries in 2. The mean time of Onyx injection was 5 sec-4 min and the volume of Onyx injected was 0.4-1.5 ml. Postoperative immediate complete embolization was achieved in 8, near-complete embolization in 11 and partial embolization in 1 (with 3 repeats of procedures). Postoperatively, there were 2 cases of ipsilateral facial numbness and 1 case of ipsilateral eyelid ptosis and eye movement disorder occurring after 3 times of arterial embolization. The follow-up period was 2-32 months, with an average of 9.5±2.7 months. In 19 patients with complete embolization and secondary embolization, the clinical symptoms disappeared completely. Among them, 18 cases of conjunctival hyperemia and ocular protrusion disappeared within 2 weeks after operation, and 1 case of heavier conjunctival edema disappeared within 3 weeks after operation. The symptoms of diplopia and vision loss improved within 1 to 3 months after surgery, and there was no recurrence. Twelve patients were followed up by DSA, and 7 patients with complete embolization showed complete occlusion of the fistula and no recurrence. Conclusion Transarterial embolization with rapid injection of Onyx may effectively treat CSDAVFs with slender feeding artery with relatively little complications and satisfactory follow-up results. Key words: Arteriovenous fistula; Dura mater; Carvernous sinus; Treatment outcome

293. Concurrent Atlantoaxial Septic Arthritis and Septic Thrombosis of the Ophthalmic Vein due to Staphylococcus aureus: A Case Report and Review of the Literature

BackgroundAtlantoaxial joint septic arthritis and superior ophthalmic vein thrombosis (SOVT) are uncommon sequelae of infections. Here, we describe a patient who presented concurrently with two uncommon manifestations of a common pathogen, methicillin-susceptible Staphylococcus aureus (MSSA), and review the associated literature. A 68-year-old man presented to the hospital with a 4-day history of worsening neck pain, right shoulder pain, and one episode of diplopia. He reported left wrist pain and swelling 3 weeks prior to presentation. A whole body 18F-positron emission tomography scan detected abnormal hypermetabolic activity in the atlantoaxial joint and in the right shoulder (Figure 1A and B). Magnetic resonance imaging revealed the presence of right SOVT (Figure 1C and D). Blood cultures grew MSSA. He underwent debridement of his right shoulder and was started on intravenous cefazolin. Conservative management of his atlantoaxial septic arthritis was unsuccessful and several weeks into his antibiotic course, he developed right-arm weakness for which he underwent C4 fusion to address atlanto-axial instability.MethodsWe reviewed previous reports describing atlantoaxial septic arthritis (n = 6) and septic ophthalmic vein thrombosis (n = 6).ResultsPrevious reports of atlantoaxial septic arthritis detailed clinical presentations of subacute to acute onset of neck pain with fever, five of which were due to S. aureus. Four of the cases required a surgical intervention involving the cervical spine. Previous reports of SOVT describe patients ipsilateral proptosis, ptosis and chemosis. In all six cases, the SOVT developed in concurrence with a head and neck infections. Three cases required surgery or an interventional procedure for source control Two cases recovered completely and three cases improved but with diplopia or permanent loss of vision in the affected eye.ConclusionEven with early recognition and prompt initiation of antibiotic therapy, our patient still suffered from long-term sequelae atlantoaxial septic arthritis and SOVT, a testament to the potential for MSSA to cause severe infections. Disclosures All authors: No reported disclosures.

Horizontal Forehead Lines: A Reflection of Eyelid Ptosis or Blepharodermachalasia.

In his facial aesthetics practice, the senior author (B.G.) observed that many patients presenting with horizontal forehead lines also demonstrated upper eyelid ptosis or enough blepharodermachalasia to require compensation. This study was conducted to investigate this observation. Photographs of patients presenting for facial rejuvenation were retrospectively reviewed for the presence of forehead lines, ptosis, brow ptosis, and blepharodermatochalasia. Patient age, gender, and race were reported. Only patients over age 50 were included. Patients who had previous eyelid or forehead surgery, congenital abnormalities, or post-traumatic deformities were excluded. Ptosis was defined as more than 1.5-mm overlap between the upper eyelid and the iris. Patients were divided into two groups based on presence of forehead lines for comparative analysis. One hundred sixty patients, including 100 patients with and 60 patients without horizontal forehead lines, were included. Patients with forehead lines were likely to be older (age 61.56 ± 8.93 vs. 58.58 ± 7.59; P = 0.0337), male (36 vs. 11.67%; P = 0.0008), have ptosis (90 vs. 76.67%; P = 0.0377), and have blepharodermatochalasis (20 vs. 5%; P = 0.0097). All 28 patients with unilateral forehead lines (17 left, 11 right) had ipsilateral ptosis. Ptosis and blepharodermatochalasis may result in the development of horizontal forehead lines through compensatory frontalis activation. Whenever horizontal forehead rhytids are noted, it is imperative to search for ptosis or blepharodermachalasia in repose. Otherwise, forehead rejuvenation may fail to eliminate these compensatory forehead lines, and chemodenervation may have significant adverse effects on the visual field by forcibly blocking frontalis compensation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .