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Journal of Cardiothoracic and Vascular... Jun 2020THE RISK FACTORS, clinical manifestation, and preventive measures of Horner syndrome (HS) caused by internal jugular vein (IJV) catheterization were explored. Electronic... (Review)
Review
THE RISK FACTORS, clinical manifestation, and preventive measures of Horner syndrome (HS) caused by internal jugular vein (IJV) catheterization were explored. Electronic databases were searched to identify all case reports of HS caused by IJV catheterization. Two authors independently extracted literature characteristics, IJV catheterization method, clinical manifestations, and prognosis data. Twenty case reports (22 patients in total) were included, 18 of which were written in English and the other 2 in Chinese. Patients were between 19 months to 65 years old, and clinical manifestations included ptosis (n = 22), miosis (n = 21), anhidrosis (n = 8), enophthalmos (n = 3), and hoarseness (n = 1). Onset of HS manifestation ranged from a few hours to 19 days after the procedure. Eight patients with ptosis, 6 patients with miosis, and 1 patient with hoarseness recovered during follow-up. Of the 22 patients, 8 underwent more than 1 attempt of IJV catheterization. Six patients experienced accidental carotid artery puncture or hematoma formation during or after IJV catheterization. Ultrasound guidance was applied in 4 patients and anatomic landmark technique was used in the other 18 patients. The left IJV was catheterized in 3 patients, and the right IJV was catheterized in 19 patients. Repeated attempts of puncture, anatomic landmark technique, accidental carotid artery puncture, or hematoma formation may increase the possibility of HS. Ptosis and miosis are the most common manifestations of HS caused by IJV catheterization.
Topics: Carotid Arteries; Catheterization, Central Venous; Horner Syndrome; Humans; Jugular Veins; Ultrasonography
PubMed: 31350153
DOI: 10.1053/j.jvca.2019.06.031 -
BMJ Case Reports Aug 2017Horner's syndrome (HS) is caused by a disruption in the oculosympathetic pathway. Both congenital and acquired HS are unusual in children. Acquired HS can be caused by...
Horner's syndrome (HS) is caused by a disruption in the oculosympathetic pathway. Both congenital and acquired HS are unusual in children. Acquired HS can be caused by trauma, surgical intervention, tumours, vascular malformations or infection.We describe the case of a 6-year-old boy who was brought to our emergency department with ptosis, miosis, painful cervical lymphadenopathy and a cat scratch on a hand. The diagnosis of a cat scratch disease was confirmed by serology. A full recovery was observed on antibiotic treatment and cervical lymphadenomegaly reduction 3 weeks later.
Topics: Animals; Anti-Bacterial Agents; Bartonella Infections; Bartonella henselae; Blepharoptosis; Cat-Scratch Disease; Cats; Child; Emergency Service, Hospital; Horner Syndrome; Humans; Lymphadenopathy; Male; Miosis; Neck; Treatment Outcome
PubMed: 28839109
DOI: 10.1136/bcr-2017-219673 -
European Annals of Otorhinolaryngology,... Oct 2019
Topics: Female; Horner Syndrome; Humans; Medical Illustration; Middle Aged; Postoperative Complications; Sympathetic Nervous System; Thyroid Gland; Thyroidectomy
PubMed: 31253593
DOI: 10.1016/j.anorl.2019.05.013 -
Asia-Pacific Journal of Ophthalmology... 2015Small pupils pose problems for cataract surgery. The pupil is dilated with topical mydriatic drugs for all cataract surgeries to improve the surgeon's access to, and... (Review)
Review
Small pupils pose problems for cataract surgery. The pupil is dilated with topical mydriatic drugs for all cataract surgeries to improve the surgeon's access to, and visualization of, the lens nucleus, cortex, and capsular structures. Limited dilation poses a risk of surgical complications such as iris trauma or tearing of the anterior or posterior capsule. There are many ways and methods to achieve the appropriate pupil dilation, from pre-operative medications to intraoperative pharmacological and/or surgical methods. A management algorithm for small pupil will be discussed in this review. The various methods and maneuvers may work in isolation or combination to achieve adequate pupil dilation.
Topics: Algorithms; Cataract Extraction; Humans; Intraoperative Complications; Iris; Miosis
PubMed: 26065497
DOI: 10.1097/APO.0000000000000119 -
Epilepsia Oct 2018Nerve agents are organophosphate (OP) compounds and among the most powerful poisons known to man. A terrorist attack on civilian or military populations causing mass... (Review)
Review
Nerve agents are organophosphate (OP) compounds and among the most powerful poisons known to man. A terrorist attack on civilian or military populations causing mass casualties is a real threat. The OP nerve agents include soman, sarin, cyclosarin, tabun, and VX. The major mechanism of acute toxicity is the irreversible inhibition of acetylcholinesterase. Acetylcholinesterase inhibition results in the accumulation of excessive acetylcholine levels in synapses, leading to progression of toxic signs including hypersecretions, tremors, status epilepticus, respiratory distress, and death. Miosis and rhinorrhea are the most common clinical findings in those individuals acutely exposed to OP nerve agents. Prolonged seizures are responsible for the neuropathology. The brain region that shows the most severe damage is the amygdala, followed by the piriform cortex, hippocampus, cortex, thalamus, and caudate/putamen. Current medical countermeasures are only modestly effective in attenuating the seizures and neuropathology. Anticonvulsants such as benzodiazepines decrease seizure activity and improve outcome, but their efficacy depends upon the administration time after exposure to the nerve agent. Administration of benzodiazepines may increase the risk for seizure recurrence. Recent studies document long-term neurologic and behavior deficits, and technological advances demonstrate structural brain changes on magnetic resonance imaging.
Topics: Acetylcholine; Acetylcholinesterase; Brain; Humans; Miosis; Nerve Agents; Respiration Disorders; Status Epilepticus; Time Factors
PubMed: 30159887
DOI: 10.1111/epi.14500 -
Indian Journal of Ophthalmology Jul 2023Cataract surgery requires a well-dilated and stable pupil for a good outcome. Unexpected pupillary constriction during surgery increases the risk of complication. This... (Review)
Review
Cataract surgery requires a well-dilated and stable pupil for a good outcome. Unexpected pupillary constriction during surgery increases the risk of complication. This problem is more pronounced in children. There are now pharmacological interventions that help tackle this unforeseen happening. Our review discusses the simple and quick options available to a cataract surgeon when faced with this dilemma. As cataract surgical techniques continue to improvise and get faster, an adequate pupil size is of paramount importance. Various topical and intra-cameral drugs are used in combination to achieve mydriasis. Despite good pre-operative dilation, the pupil can be quite unpredictable during surgery. Intra-operative miosis limits the field of surgery and increases the risk of complications. For example, if the pupil size decreases from 7 mm to 6 mm, this 1 mm change in pupil diameter will lead to a decrease of 10.2 mm in the area of surgical field. Making a good capsulorhexis with a small pupil can be a challenge, even for an experienced surgeon. Repeated touching of the iris increases the risk of fibrinous complications. Removal of cataract and the cortical matter becomes increasingly difficult. Intra-ocular lens implantation in the bag also requires adequate dilation. When dealing with challenging cases like lens subluxation, pseudo-exfoliation, and zonular dehiscence, a small pupil further increases the risk and adversely affects the surgical outcome. Hence, achieving and maintaining adequate mydriasis throughout surgery is essential. This review highlights the risk factors for small pupils during surgery and current management strategies.
Topics: Child; Humans; Mydriasis; Cataract Extraction; Miosis; Pupil; Cataract; Phacoemulsification
PubMed: 37417103
DOI: 10.4103/IJO.IJO_3384_22 -
Ugeskrift For Laeger Mar 2016Dissection of the cervical arteries is an important cause of stroke in young adults. A haematoma in the wall of the cervical vessel leads to stenosis or occlusion and... (Review)
Review
Dissection of the cervical arteries is an important cause of stroke in young adults. A haematoma in the wall of the cervical vessel leads to stenosis or occlusion and thereby risk of stroke. The most frequent local symptoms in carotid-artery dissection are head- and neck pain accompanied by Horner's syndrome, while typical symptoms in vertebral-artery dissection are pain in the back of the neck and head. The mural haematoma is best visualized by magnetic resonance imaging. Antithrombotic versus anticoagulation treatment to prevent stroke have recently shown to be equally effective.
Topics: Anticoagulants; Back Pain; Carotid Artery, Internal, Dissection; Fibrinolytic Agents; Headache; Horner Syndrome; Humans; Magnetic Resonance Imaging; Neck Pain; Stroke; Tomography, X-Ray Computed; Vertebral Artery Dissection; Young Adult
PubMed: 27045796
DOI: No ID Found -
Pharmacology, Biochemistry, and Behavior Dec 2021Regular alcohol consumption is on the rise among older adults and has the potential of altering the subjective experience of pain and response to pain medications. This...
BACKGROUND
Regular alcohol consumption is on the rise among older adults and has the potential of altering the subjective experience of pain and response to pain medications. This study examined the cognitive, analgesic and side effect response to oxycodone in middle age and older adults with elevated levels of customary alcohol consumption in a human laboratory setting.
METHODS
After refraining from alcohol for one day, eligible participants underwent baseline assessment cognition and side effects by means of questionnaires that were repeated at three time points (90 min, 5 and 8 h) following administration of a 10 mg oral dose of oxycodone. Response to pain stimulus (Cold Pressor Test (CPT)), pupil size, and plasma oxycodone were also measured.
RESULTS
One hundred twenty-eight adults (age 35-85) completed the study day. Compared to those with lower customary alcohol consumption, participants with elevated alcohol consumption showed attenuated opioid-induced pupil constriction and cognitive decline on objective measures of working memory, sustained attention, inhibitory control, coordination on a simulated driving task, and subjective dysphoric effects with enhanced subjective euphoric effects. Oxycodone pharmacokinetics, pain tolerance to CPT, and Berg balance were impacted comparably between alcohol consumption groups. Women endorsed greater negative drug effects, whereas men endorsed positive drug effects.
CONCLUSION
Independent of subject's age, elevated customary alcohol consumption attenuates opioid central effects (i.e., pupil miosis, impaired cognition) and gender influences subjective drug effects. Clinicians should consider alcohol consumption and gender when prescribing opioid medications.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Alcohol Drinking; Analgesics, Opioid; Attention; Automobile Driving; Cognition; Ethanol; Female; Humans; Male; Memory, Short-Term; Middle Aged; Miosis; Oxycodone; Pain; Sex Factors; Surveys and Questionnaires
PubMed: 34742948
DOI: 10.1016/j.pbb.2021.173295 -
Insight (American Society of Ophthalmic... Apr 1996Nonsteroidal antiinflammatory drugs have unique properties that aid the cataract surgeon. In phacoemulsification surgery, patients routinely receive nonsteroidal... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial Review
Nonsteroidal antiinflammatory drugs have unique properties that aid the cataract surgeon. In phacoemulsification surgery, patients routinely receive nonsteroidal antiinflammatory drugs along with their dilating drops to inhibit intraoperative miosis. After surgery, these drugs can control inflammation and inhibit the development of cystoid macular edema. We present two prospective randomized studies. In the first, diclofenac sodium was compared with prednisolone acetate for control of postoperative inflammation. In the second, diclofenac sodium was compared with flurbiprofen for inhibition of intraoperative miosis. Diclofenac sodium was found to be as effective as prednisolone acetate for control of postoperative inflammation and as effective as flurbiprofen for inhibition of intraoperative miosis. Thus, whereas in the past we used a nonsteroidal antiinflammatory drug before surgery for inhibition of intraoperative miosis and a steroid drop in the postoperative period to control postsurgical inflammation, we now have equal efficacy using the same drug in the entire perioperative period.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Cataract Extraction; Diclofenac; Flurbiprofen; Humans; Postoperative Care; Prednisolone; Premedication; Treatment Outcome
PubMed: 8826226
DOI: 10.1016/s1060-135x(96)90025-1 -
Journal of Healthcare Engineering 2022Horner syndrome is a clinical constellation that presents with miosis, ptosis, and facial anhidrosis. It is important as a warning sign of the damaged oculosympathetic...
Horner syndrome is a clinical constellation that presents with miosis, ptosis, and facial anhidrosis. It is important as a warning sign of the damaged oculosympathetic chain, potentially with serious causes. However, the diagnosis of Horner syndrome is operator dependent and subjective. This study aims to present an objective method that can recognize Horner sign from facial photos and verify its accuracy. A total of 173 images were collected, annotated, and divided into training and testing groups. Two types of classifiers were trained (two-stage classifier and one-stage classifier). The two-stage method utilized the MediaPipe face mesh to estimate the coordinates of landmarks and generate facial geometric features accordingly. Then, ten machine learning classifiers were trained based on this. The one-stage classifier was trained based on one of the latest algorithms, YOLO v5. The performance of the classifier was evaluated by the diagnosis accuracy, sensitivity, and specificity. For the two-stage model, the MediaPipe successfully detected 92.2% of images in the testing group, and the Decision Tree Classifier presented the highest accuracy (0.790). The sensitivity and specificity of this classifier were 0.432 and 0.970, respectively. As for the one-stage classifier, the accuracy, sensitivity, and specificity were 0.65, 0.51, and 0.84, respectively. The results of this study proved the possibility of automatic detection of Horner syndrome from images. This tool could work as a second advisor for neurologists by reducing subjectivity and increasing accuracy in diagnosing Horner syndrome.
Topics: Humans; Horner Syndrome; Algorithms; Machine Learning
PubMed: 36451761
DOI: 10.1155/2022/8670350