Horner's Syndrome
Non-congenital unilateral Horner's syndrome is usually an indication of serious neurological disease or damage. It may exist in isolation or as part of Wallenberg's or Pancoast syndrome in any event, the recognition of Horner's syndrome is of paramount importance and a more than superficial understanding of its pathology and relevance helpful. The following questions concern the clinical manifestations of this syndrome and its implications.
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What clinical signs comprise Horner's syndrome?
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Which component of the neurological system must be damaged to produce Horner's syndrome?
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What sites in neurological system must the damage or the disease process affect?
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What is your main concern for a patient with Horner's syndrome?
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What steps do you take once you have identified Horner's syndrome?
1. The clinical signs of Horner's syndrome:
Ptosis, miosis, enopthalamus, facial reddening, anhydrosis.
2. The components of the neurological system must be damaged:
Horner's is caused by a sympathetic paralysis.
3. The damage or the disease must affect:
Either pre or postganglionic lesions can cause the condition but this cannot be determined from the clinical physical examination. Sites of damage can be the thalamus, reticular formation, descending sympathetic nerve, the inferior or superior cervical ganglia.
4. Your main concern for a patient with Horner's syndrome:
Horner's can be congenital or acquired. Acquired causes include brainstem or thalamic tumors; vertebrobasilar ischaemia, brainstem trauma, breast or apical lung cancer (Pancoast syndrome), damage to the cervicothoracic outflow or damage to the inferior or superior cervical ganglion. Of these, preganglionic Horner's is most serious as the lesion lies in rostral to the inferior cervical ganglion and includes brainstem, lung and breast cancers and possibly most likely for the OMT, vertebrobasilar ischaemia in which case other brainstem and long tract signs should be present.
5. Steps once you have identified Horner's syndrome:
The patient should immediately be returned or referred to a physician for further evaluation and not treated again until you are satisfied that the cause is a relatively benign.
References:
Just about any halfway decent neurology text will give information on Horner's but these are fairly good.
Gilman, S, Newman, SW. Manter and Gatz's Essentials of Clinical
Neuroanatomy and Neurophysiology, 7th Edition FA Davis Company Philadelphia 1987
Adams, RD. Victor, M. Principles of Neurology, 3rd Edition McGraw-Hill Book Company, NY. 1985
Disclaimer:
The assessment and treatment techniques depicted or described in this site are not intended to replace formal instruction in orthopedic manual or any other type of physical therapy. They are intended to review, augment and facilitate the knowledge and skills previously gained on manual therapy or other course and to stimulate the untrained or trainee physical therapist to increase the bounds of his or her knowledge and skill base.
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