“Horner Syndrome” (Eastern WA)

Since 2014, The Samaritan Riders Spokane have been raising public awareness of childhood disease affecting local children in the Eastern Washington Region. Their 2021 childhood illness awareness campaign begins with Horner Syndrome.

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HORNER SYNDROME is a classic neurologic syndrome whose signs include miosis (excessive constriction of the pupils), ptosis (a drooping upper eyelid) and anhidrosis (a sweat gland that doesn’t make sweat). Also called oculosympathetic paresis, a Horner syndrome can be produced by a lesion anywhere along the sympathetic [nerve] pathway that supplies the head, eye and neck. Causes range from benign to serious, requiring a methodologic approach to diagnostic evaluation.

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CHILDREN – The etiology of Horner syndrome in infants and children differs from that of the adult population. Classic causes include birth trauma, neuroblastoma, vascular anomalies of the large arteries, and chest surgery.

The most common cause is delivery-related trauma to the neck and shoulder, damaging the sympathetic [nerve] pathway. Associated injury in the lower brachial plexus can produce weakness in the ipsilateral (same side) forearm and hand (Klumpke’s paralysis).

In the absence of a clear history of birth trauma, an acquired Horner syndrome in a child should prompt evaluation for a tumor, particularly a paraspinal neuroblastoma, which is known to present with a Horner syndrome.

In infants and children, impaired facial flushing (Harlequin sign) is often more apparent than anhidrosis. Acute features of sympathetic [nerve] disruption can also include ipsilateral conjunctival injection (irritation of the whites of the eyes), nasal stuffiness, and increased near point of accommodation.

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Authors: Sachin Kedar, MD, Valerie Biousse, MD, Nancy J Newman, MD. Printed from UpToDate 12/2020.

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