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American Family Physician Feb 2019
Topics: Aged; Anisocoria; Diagnosis, Differential; Female; Horner Syndrome; Humans
PubMed: 30702257
DOI: No ID Found -
The Israel Medical Association Journal... Jan 2017The identification and prompt diagnosis of Horner syndrome (HS) is essential for preventing permanent damage. HS may arise when a lesion presents anywhere along the... (Review)
Review
The identification and prompt diagnosis of Horner syndrome (HS) is essential for preventing permanent damage. HS may arise when a lesion presents anywhere along the three-neuron oculosympathetic pathway that begins at the posterior-lateral nuclei of the hypothalamus all the way through to the orbit. We present four cases and review the literature to familiarize the reader with the identification, diagnosis and treatment of Horner syndrome. The four patients, three adults and one child, were followed for at least 6 months following the initial diagnosis (range 6-18 months). There was partial resolution in three of the four cases, while the fourth resolved completely. There are numerous causes of HS, some of them iatrogenic. While iatrogenic cases of HR are rare in both adults and children, HS is seen more often following surgical procedures. Prompt recognition of the syndrome and correction of the offending agent may prevent permanent damage to the neuronal pathway. It is therefore recommended that practitioners be aware of the risks for development of iatrogenic HS and the signs for early detection.
Topics: Adult; Aged; Anisocoria; Blepharoptosis; Female; Horner Syndrome; Humans; Iatrogenic Disease; Infant; Male; Young Adult
PubMed: 28457112
DOI: No ID Found -
Thorax Jul 1971Thirty-two mediastinal neural tumours were seen in the East Anglian Regional Thoracic Surgical Unit at Cambridge between October 1952 and July 1970. The descending order... (Review)
Review
Thirty-two mediastinal neural tumours were seen in the East Anglian Regional Thoracic Surgical Unit at Cambridge between October 1952 and July 1970. The descending order of frequency was neurofibroma, ganglioneuroma, neurilemmoma, neurofibrosarcoma, and neuroblastoma. The literature relating to these tumours is reviewed and the pathological and clinical complications encountered in this series and in the literature are described.
Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Deglutition Disorders; Female; Ganglioneuroma; Horner Syndrome; Humans; Hypertension; Infant; Infant, Newborn; Lung Diseases; Lung Neoplasms; Male; Mediastinal Neoplasms; Mediastinum; Meningocele; Middle Aged; Neoplasm Regression, Spontaneous; Neoplasms, Nerve Tissue; Neurilemmoma; Neuroblastoma; Neurofibroma; Neurofibromatosis 1; Neurologic Manifestations; Osteoarthropathy, Secondary Hypertrophic; Pain; Paraganglioma, Extra-Adrenal; Pheochromocytoma; Sex Factors; Vitamin B 12
PubMed: 4327710
DOI: 10.1136/thx.26.4.392 -
The American Journal of Case Reports Jan 2021BACKGROUND Fibrosing mediastinitis is a rarely seen, progressive disease. It results from an excessive fibrotic reaction in the mediastinum. We describe a presentation...
BACKGROUND Fibrosing mediastinitis is a rarely seen, progressive disease. It results from an excessive fibrotic reaction in the mediastinum. We describe a presentation of fibrosing mediastinitis that, to our knowledge, has never been seen before. CASE REPORT A 30-year-old female Colombian flight attendant presented with a right eyelid droop. Examination revealed partial right-sided ptosis and miosis but no anhidrosis. An ill-defined firm swelling was palpable at the root of the neck. Chest radiography revealed a widened mediastinum, and computerized tomography (CT) showed a right paratracheal mass without calcification extending to the thoracic inlet, encasing multiple blood vessels. All basic blood tests, magnetic resonance imaging of the head, and ultrasound Doppler of the neck vessels were normal. History and work up for infections including fungal diseases, granulomatous diseases, vasculitis, and autoimmune diseases were negative. Positron emission tomography (PET) showed significant FDG uptake in the mediastinum. Mediastinal biopsy was histologically consistent with fibrosing mediastinitis. All relevant immunohistochemistry and microbiological studies were negative. Subsequently, the patient developed signs of superior vena cava compression; this was managed by balloon angioplasty, which resulted in improvement of symptoms. However, over time, her symptoms worsened progressively, resulting in a left-sided ptosis and radiological progression of the mass on CT. She received treatment with rituximab and concomitant steroids, which yielded excellent results: the treatment led to both resolution of her symptoms and regression of the mass and its metabolic activity on PET scan. CONCLUSIONS Fibrosing mediastinitis can present with an incomplete Horner's syndrome. Treatment with rituximab and steroids shows promising results in select cases of metabolically active idiopathic fibrosing mediastinitis.
Topics: Adult; Blepharoptosis; Female; Humans; Mediastinitis; Miosis; Sclerosis
PubMed: 33431787
DOI: 10.12659/AJCR.927556 -
Neurology India 2022
Topics: Horner Syndrome; Humans; Stents; Tomography, X-Ray Computed
PubMed: 36076683
DOI: 10.4103/0028-3886.355103 -
Cell Calcium Jun 2019Ca release-activated Ca (CRAC) channels are intimately linked with health and disease. The gene encoding the CRAC channel, ORAI1, was discovered in part by genetic... (Review)
Review
Ca release-activated Ca (CRAC) channels are intimately linked with health and disease. The gene encoding the CRAC channel, ORAI1, was discovered in part by genetic analysis of patients with abolished CRAC channel function. And patients with autosomal recessive loss-of-function (LOF) mutations in ORAI1 and its activator stromal interaction molecule 1 (STIM1) that abolish CRAC channel function and store-operated Ca entry (SOCE) define essential functions of CRAC channels in health and disease. Conversely, gain-of-function (GOF) mutations in ORAI1 and STIM1 are associated with tubular aggregate myopathy (TAM) and Stormorken syndrome due to constitutive CRAC channel activation. In addition, genetically engineered animal models of ORAI and STIM function have provided important insights into the physiological and pathophysiological roles of CRAC channels in cell types and organs beyond those affected in human patients. The picture emerging from this body of work shows CRAC channels as important regulators of cell function in many tissues, and as potential drug targets for the treatment of autoimmune and inflammatory disorders.
Topics: Animals; Blood Platelet Disorders; Calcium; Calcium Release Activated Calcium Channels; Calcium Signaling; Channelopathies; Disease Models, Animal; Drug Discovery; Dyslexia; Erythrocytes, Abnormal; Humans; Ichthyosis; Migraine Disorders; Miosis; Muscle Fatigue; Mutation; Myopathies, Structural, Congenital; Neoplasm Proteins; ORAI1 Protein; Spleen; Stromal Interaction Molecule 1
PubMed: 31009822
DOI: 10.1016/j.ceca.2019.03.004 -
BMJ Case Reports Jan 2015A 64-year-old man presented with a 2-day history of acute onset painless left ptosis. He had no other symptoms; importantly pupils were equal and reactive and eye...
A 64-year-old man presented with a 2-day history of acute onset painless left ptosis. He had no other symptoms; importantly pupils were equal and reactive and eye movements were full. There was no palpable mass or swelling. He was systemically well with no headache, other focal neurological signs, or symptoms of fatigue. CT imaging showed swelling of the levator palpebrae superioris suggestive of myositis. After showing no improvement over 5 days the patient started oral prednisolone 30 mg reducing over 12 weeks. The ptosis resolved quickly and the patient remains symptom free at 6 months follow-up. Acute ptosis may indicate serious pathology. Differential diagnoses include a posterior communicating artery aneurysm causing a partial or complete third nerve palsy, Horner's syndrome, and myasthenia gravis. A careful history and examination must be taken. Orbital myositis typically involves the extraocular muscles causing pain and diplopia. Isolated levator myositis is rare.
Topics: Blepharoptosis; Diagnosis, Differential; Diplopia; Eye Movements; Eyelids; Horner Syndrome; Humans; Male; Middle Aged; Muscle, Skeletal; Myasthenia Gravis; Oculomotor Muscles; Oculomotor Nerve Diseases; Orbital Myositis; Prednisolone
PubMed: 25564592
DOI: 10.1136/bcr-2014-207720 -
Light- and drug-induced pupillary dynamics in eyes with a retropupillary iris-claw intraocular lens.Graefe's Archive For Clinical and... Aug 2023We evaluated the pupillary characteristics and response to light and drugs in eyes with posterior chamber (PC) placement of iris-claw intraocular lens (IC-IOL).
PURPOSE
We evaluated the pupillary characteristics and response to light and drugs in eyes with posterior chamber (PC) placement of iris-claw intraocular lens (IC-IOL).
METHODS
In this cross-sectional, comparative study, we included adults with an IC-IOL implanted in the PC of a single eye. We excluded patients with ocular trauma, postoperative IC-IOL displacement or complications, and extended iris atrophy. We used anterior segment optical coherence tomography to perform light-controlled pupillography, measure the pupil diameter (PD), and estimated the pupil circularity under mesopic conditions. PD was also assessed under photopic, scotopic, pharmacological mydriasis, and miosis conditions. The results were compared to those of the fellow eye, phakic, or regular pseudophakic.
RESULTS
The IC-IOL and control groups included 30 eyes each. The most frequent reasons for IC-IOL implantation were complicated cataract (37%) and dislocated/luxated prior IOL (33%). Compared to the control group, the IC-IOL group had lower visual acuity, a smaller PD under scotopic conditions (p = 0.0010) and after pharmacological mydriasis (p < 0.0001), and a larger PD after pharmacological miosis (p < 0.0001). Mesopic pupil circularity was comparable between the groups. We also considered ongoing extraocular treatments with possible effects on iris motility.
CONCLUSIONS
The pupillary size and profile were similar between the groups in mesopic light. Reduced mydriasis was noted in response to light and drugs, while the degree of miosis was reduced in response to inducing drugs in the IC-IOL compared to the control group. This study complements previous results concerning the PC placement of IC-IOLs by adding original observations on drug-induced pupil motility.
Topics: Adult; Humans; Pupil; Lens Implantation, Intraocular; Mydriasis; Cross-Sectional Studies; Lenses, Intraocular; Miosis
PubMed: 36859737
DOI: 10.1007/s00417-023-06025-0 -
Eye (London, England) Mar 2013The diagnosis of Horner's syndrome (HS) can be difficult, as patients rarely present with the classic triad of ptosis, miosis, and anhydrosis. Frequently, there are no... (Review)
Review
The diagnosis of Horner's syndrome (HS) can be difficult, as patients rarely present with the classic triad of ptosis, miosis, and anhydrosis. Frequently, there are no associated symptoms to help determine or localise the underlying pathology. The onset of anisocoria may also be uncertain, with many cases referred after incidental discovery on routine optometric assessment. Although the textbooks discuss the use of cocaine, apraclonidine, and hydroxyamphetamine to diagnose and localise HS, in addition to reported false positive and negative results, these pharmacological agents are rarely available during acute assessment or in general ophthalmic departments. Typically, a week is required between using cocaine or apraclonidine for diagnosis and localisation of HS with hydroxyamphetamine, leaving the clinician with the decision of which investigations to request and with what urgency. Modern imaging modalities have advanced significantly and become more readily available since many of the established management algorithms were written. We thus propose a practical and safe combined clinical and radiological diagnostic protocol for HS that can be applied in most clinical settings.
Topics: Adult; Algorithms; Angiography, Digital Subtraction; Clonidine; Cocaine; Diagnostic Imaging; Horner Syndrome; Humans; Magnetic Resonance Imaging; Mydriatics; p-Hydroxyamphetamine
PubMed: 23370415
DOI: 10.1038/eye.2012.281 -
Journal of AAPOS : the Official... Jun 1998The purpose of this study was to define the etiologies of Horner syndrome in the pediatric population.
INTRODUCTION
The purpose of this study was to define the etiologies of Horner syndrome in the pediatric population.
METHODS
A retrospective review was performed of the medical records of all pediatric Horner syndrome patients (< 18 years old) examined by the pediatric ophthalmology services at two large referral centers.
RESULTS
Seventy-three pediatric Horner syndrome patients were identified. Of these, 31 (42%) were congenital, 11 (15%) were acquired without surgical intervention, and 31 (42%) were acquired after a surgical procedure of the thorax, neck, or central nervous system. Of the congenital Horner syndrome patients, a history of delivery with the use of forceps, vacuum extraction, shoulder dystocia, fetal rotation, or postterm delivery was elicited in 16 patients (53%). Concomitant brachial plexus injury was identified in only 3 patients. Two patients had congenital varicella syndrome and 1 patient was diagnosed with neuroblastoma. This patient had a palpable supraclavicular mass and stridor. Diagnosis of the patients with acquired Horner syndrome included neuroblastoma (2), trauma (1), rhabdomyosarcoma (1), brainstem vascular malformation (1), disseminated sclerosis (1), and not determined (5).
CONCLUSION
In children with congenital Horner syndrome, a history of forceful manipulation of the infant during birth may reduce the need for extensive systemic evaluation. Without such history, a decision to proceed with further evaluation is made with consideration of the relative incidence of neuroblastoma by age and the physical findings. All acquired pediatric Horner syndrome patients without a known etiology require thorough evaluation because of the frequent association of serious underlying disease.
Topics: Birth Injuries; Child; Child, Preschool; Communicable Diseases; Horner Syndrome; Humans; Infant; Neoplasms; Neuroblastoma; Practice Guidelines as Topic; Retrospective Studies
PubMed: 10532753
DOI: 10.1016/s1091-8531(98)90008-8