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Practical Neurology Mar 2024A 62-year-old man attended ophthalmology for a simple ptosis repair. He had a chronic cough, a Horner's syndrome with post-gustatory hyperhidrosis. He was referred to...
A 62-year-old man attended ophthalmology for a simple ptosis repair. He had a chronic cough, a Horner's syndrome with post-gustatory hyperhidrosis. He was referred to the respiratory and neurology teams. MR scan of his head and neck found evidence of multifocal disease at the skull base and carotid canal, and further tests identified additional deposits in the hilar lymph nodes, heart and sacrum. A transbronchial biopsy confirmed the diagnosis of sarcoidosis. His symptoms and imaging responded well to corticosteroids, but he still undergoes regular imaging. We discuss the features of Horner's syndrome, and the autonomic associations of a chronic cough.
Topics: Male; Humans; Middle Aged; Horner Syndrome; Chronic Cough; Sarcoidosis; Central Nervous System Diseases
PubMed: 38160054
DOI: 10.1136/pn-2023-003816 -
Journal of the American Veterinary... Sep 2023
Topics: Dogs; Animals; Nictitating Membrane; Miosis; Horner Syndrome; Dog Diseases
PubMed: 37315938
DOI: 10.2460/javma.23.04.0196 -
European Review For Medical and... Nov 2023The aim of this study was to compare the efficacy and safety of ultrasound-guided stellate ganglion block (SGB) with different volumes of 0.375% ropivacaine on sleep... (Comparative Study)
Comparative Study
OBJECTIVE
The aim of this study was to compare the efficacy and safety of ultrasound-guided stellate ganglion block (SGB) with different volumes of 0.375% ropivacaine on sleep quality in patients with insomnia.
PATIENTS AND METHODS
A total of 80 patients who were selected to undergo SGB for the treatment of insomnia were enrolled. The patients were divided into saline control group, and low-volume (4 mL), medium-volume (6 mL), and high-volume (8 mL) ropivacaine injection groups according to the random table method. The treatment included 7 blocks with once every three days. The left and right stellate ganglions are alternately blocked. The onset and maintenance time of Horner syndrome, the degree of carotid artery dilation and blood flow velocity before and 20 minutes after the first block, the occurrence of complications such as drug crossing of the midline of the artery and hoarse throat were recorded, and the improvement of sleep disorders was evaluated with the Pittsburgh Sleep Quality Index Scale.
RESULTS
Horner syndrome occurred in 100% of all volumes of ropivacaine block. The ipsilateral internal carotid artery was dilated and was accompanied by increased blood flow. The degree of dilation and increase in blood flow were not affected by the volumes of drug injection. There were no serious complications in any group, but the incidences of hoarseness and dysphagia were higher in the medium- and high-volume groups than those in the low-volume group (all p < 0.05). Compared with the low- and medium-volume groups, the high-volume group had a faster onset of action, longer maintenance time, and the highest chance of the drug crossing the artery (all p < 0.05). Compared to those before the pre-block and in the control groups, insomnia was improved in all volume groups after the block with nonsignificant intergroup differences.
CONCLUSIONS
4 mL of 0.375% ropivacaine for ultrasound-guided SGB is sufficient to improve the sleep quality of insomnia patients, whose overall risk is lower than block with 6 mL or 8 mL of ropivacaine.
Topics: Humans; Anesthetics, Local; Autonomic Nerve Block; Horner Syndrome; Ropivacaine; Sleep Initiation and Maintenance Disorders; Sleep Quality; Stellate Ganglion
PubMed: 37975347
DOI: 10.26355/eurrev_202311_34298 -
Ear, Nose, & Throat Journal May 2024Schwannoma arising from cervical sympathetic chain (CSC) is a rare clinical entity. CSC is hard to preserve in CSC schwannoma (CSCS) surgeries, resulting in Horner's...
OBJECTIVES
Schwannoma arising from cervical sympathetic chain (CSC) is a rare clinical entity. CSC is hard to preserve in CSC schwannoma (CSCS) surgeries, resulting in Horner's syndrome (HS) and first bite syndrome (FBS). This article aims to explore our experience in successful preservation of CSC in CSCS surgeries.
METHODS
This is a retrospective review of CSCS cases treated at our tertiary medical institution between Apr 2018 and March 2022. Only cases with successful intraoperative preservation of CSC were included.
RESULTS
In total, 3 cases were included. There were 2 male patients and 1 female patient. Their age was between 38 years old and 66 years old (average and median age was 52 and 51 years old, respectively). Presenting symptom was neck mass for all them, 2 of which were on the left side, while 1 was on the right. Intracapsular enucleation of the CSCS was attempted and achieved in all 3 cases. Hemorrhage from the inner surface of capsules was diffuse and heavy. Constant saline irrigation, suction, and bipolar coagulation were needed to achieve hemostasis. Postoperative HS presented between 4 hours and 14 hours after surgery for all 3 patients, which took 1 month to 3 months to recover, whereas FBS did not occur in any patient. Median duration of follow-up was 6 months. No recurrence was observed.
CONCLUSIONS
Intracapsular enucleation should be attempted in CSCS surgeries, although hemorrhage might be diffuse and hard to control. When intracapsular enucleation was achieved, postoperative FBS can be avoided, while postoperative HS could occur, but its recovery was satisfactory.
Topics: Humans; Neurilemmoma; Female; Middle Aged; Male; Retrospective Studies; Adult; Aged; Horner Syndrome; Treatment Outcome; Postoperative Complications; Head and Neck Neoplasms
PubMed: 36069381
DOI: 10.1177/01455613221124777 -
Forensic Science, Medicine, and... Mar 2024The "facie sympathique" is a vital sign first described by Etienne Martin in 1899 referring to unilateral miosis, with or without ptosis, at the opposite side from the... (Review)
Review
The "facie sympathique" is a vital sign first described by Etienne Martin in 1899 referring to unilateral miosis, with or without ptosis, at the opposite side from the knot in hanging. This mark is scarcely reported in legal medicine textbooks and scientific papers. Moreover, when cited, it is referred to differently from its original meaning, both as unilateral contraction (miosis) and dilatation (mydriasis) of the pupil depending on the antemortem firmness of the ligature's neck pressure in hanging with little attention to ptosis. Due to the sympathetic nervous pathway supplying the eye, the review of this ocular sign in hanging supports the importance of revitalizing the "facie sympathique" in research on lesion vitality in mechanical asphyxia.
Topics: Humans; Neck Injuries; Facies; Neck; Forensic Medicine; Miosis; Asphyxia
PubMed: 36892805
DOI: 10.1007/s12024-023-00603-8 -
Journal of Neuro-ophthalmology : the... Mar 2024
Topics: Humans; Horner Syndrome
PubMed: 36477585
DOI: 10.1097/WNO.0000000000001769 -
Frontiers in Veterinary Science 2023A 7-year-old castrated male American Shorthair cat presented with left-side Horner's syndrome and voice change. The overall clinical presentation included dysphagia,...
A 7-year-old castrated male American Shorthair cat presented with left-side Horner's syndrome and voice change. The overall clinical presentation included dysphagia, intermittent coughing, unilateral miosis, and third eyelid protrusion of the left eye. A topical 1% phenylephrine was applied, and miosis and protrusion of the third eyelid disappeared within 20 min which suggested a post-ganglionic lesion. Laryngoscopy showed left-sided laryngeal paralysis. Computed tomography (CT) identified a mass lesion invading outside of the left tympanic bulla with osteolysis. Endoscopically assisted ventral bulla osteotomy was performed for tumor resection and definitive diagnosis. Middle ear adenocarcinoma was diagnosed based on histopathology. It appears that these neurological signs occurred due to adenocarcinoma in the tympanic bulla, penetrating the jugular foramen and the hypoglossal canal and damaging the cranial nerve IX (glossopharyngeal nerve), X (vagus nerve), XI (accessory nerve), and XII (hypoglossal nerve) and the sympathetic nerve. To the best of our knowledge, this is the first case report of Villaret's syndrome associated with middle ear adenocarcinoma affecting the nerves passing through the jugular foramen and hypoglossal canal in cats.
PubMed: 37576831
DOI: 10.3389/fvets.2023.1225567 -
Ophthalmic & Physiological Optics : the... Nov 2023This study presents a novel video-based eye-tracking system for analysing the dynamics of the binocular near-reflex response. The system enables the simultaneous...
PURPOSE
This study presents a novel video-based eye-tracking system for analysing the dynamics of the binocular near-reflex response. The system enables the simultaneous measurement of convergence, divergence and pupillary size during accommodation and disaccommodation to aid the comprehensive understanding of the three-component near-reflex.
METHODS
A high-speed (90 Hz) video-based eye tracker was used to capture changes in eye gaze and pupil radius in 15 participants in response to altering stimulus conditions. An offline analysis involved separating the gaze vector components and pupil radius, which were fitted to a hyperbolic tangent function to characterise the dynamics of the near-reflex process.
RESULTS
Significant differences in the temporal parameters of the pupil radius were observed between the near-to-far and far-to-near vision changes, with faster miosis compared with mydriasis. Additionally, differences in response times were found between gaze angle components, with longer convergence times compared to changes in the vertical direction (saccades). The steady-state values of the gaze components and pupil radius were in line with theoretical expectations and previous reports.
CONCLUSIONS
The proposed system provides a non-invasive, portable and cost-effective method for evaluating near-reflex dynamics under natural viewing conditions using a video-based eye tracker. The sampling rate ensures the accurate assessment of vergence eye movements and pupillary dynamics. By simultaneously measuring eye convergence, divergence and pupil size, the system offers a more comprehensive assessment of the near-reflex response. This makes it a valuable tool for clinical diagnosis, research studies and investigating the effects of near work on the visual system.
PubMed: 37470168
DOI: 10.1111/opo.13203 -
JCI Insight Mar 2024Tubular aggregate myopathy (TAM) and Stormorken syndrome (STRMK) are clinically overlapping disorders characterized by childhood-onset muscle weakness and a variable...
Tubular aggregate myopathy (TAM) and Stormorken syndrome (STRMK) are clinically overlapping disorders characterized by childhood-onset muscle weakness and a variable occurrence of multisystemic signs, including short stature, thrombocytopenia, and hyposplenism. TAM/STRMK is caused by gain-of-function mutations in the Ca2+ sensor STIM1 or the Ca2+ channel ORAI1, both of which regulate Ca2+ homeostasis through the ubiquitous store-operated Ca2+ entry (SOCE) mechanism. Functional experiments in cells have demonstrated that the TAM/STRMK mutations induce SOCE overactivation, resulting in excessive influx of extracellular Ca2+. There is currently no treatment for TAM/STRMK, but SOCE is amenable to manipulation. Here, we crossed Stim1R304W/+ mice harboring the most common TAM/STRMK mutation with Orai1R93W/+ mice carrying an ORAI1 mutation partially obstructing Ca2+ influx. Compared with Stim1R304W/+ littermates, Stim1R304W/+Orai1R93W/+ offspring showed a normalization of bone architecture, spleen histology, and muscle morphology; an increase of thrombocytes; and improved muscle contraction and relaxation kinetics. Accordingly, comparative RNA-Seq detected more than 1,200 dysregulated genes in Stim1R304W/+ muscle and revealed a major restoration of gene expression in Stim1R304W/+Orai1R93W/+ mice. Altogether, we provide physiological, morphological, functional, and molecular data highlighting the therapeutic potential of ORAI1 inhibition to rescue the multisystemic TAM/STRMK signs, and we identified myostatin as a promising biomarker for TAM/STRMK in humans and mice.
Topics: Animals; Mice; Blood Platelet Disorders; Calcium; Dyslexia; Erythrocytes, Abnormal; Ichthyosis; Migraine Disorders; Miosis; Muscle Fatigue; Myopathies, Structural, Congenital; ORAI1 Protein; Spleen
PubMed: 38516893
DOI: 10.1172/jci.insight.174866 -
Neurologia I Neurochirurgia Polska Jun 2024Trigeminal autonomic cephalgias (TACs) are a well-defined subset of uncommon primary headaches that share comparable onset, pathophysiology and symptom patterns. TACs...
Trigeminal autonomic cephalgias (TACs) are a well-defined subset of uncommon primary headaches that share comparable onset, pathophysiology and symptom patterns. TACs are characterised by the presentation of one-sided and high-intensity trigeminal pain together with unilateral cranial autonomic signs, which can include lacrimation, rhinorrhea, and miosis. The International Classification of Headache Disorders 3rd Edition recognises four different headache entities in this group, with cluster headache as the most recognised among them. Hemicrania continua (HC) and paroxysmal hemicrania (PH) are both distinctive cephalgias of which the diagnostic criteria include an absolute response to indomethacin. Consequently, for this reason they are often referred to as 'indomethacin-responsive' TACs. The main focus of this review was to discuss the state of knowledge regarding the pathophysiology and key characteristics of PH and HC. Given the limited understanding of these conditions, and their exceptionally uncommon prevalence, a correct diagnosis can pose a clinical challenge and the search for an effective treatment may be prolonged, which frequently has a serious impact upon patients' quality of life. The information provided in this review is meant to help physicians to differentiate indomethacin-sensitive cephalgias from other distinct headache disorders with a relatively similar clinical presentation, such as cluster headache, trigeminal neuralgia, and various migraine conditions.
PubMed: 38935422
DOI: 10.5603/pjnns.99747