On the basis of the etiologic background, there are two ways of imaging patients with. Therefore, the presence of occult malignancy should be considered in any patient with shoulder or arm pain and new horner syndrome without a history of trauma 1. Tumor from the apex of the lung can cause horner syndrome accompanied by shoulder and arm pain, also known as pancoast syndrome. Considered to be a rare condition, horner syndrome is. This site provides clear and easily accessible guide to many of the practical aspects of mri including mri protocols, mri planning, mri anatomy, mri techniques, mri safety and much more. Horner syndrome results from an interruption of the oculosympathetic. Neuroimaging strategies for three types of horner syndrome. Pdf the harlequin sign and congenital horners syndrome. The miotic pupil in horner syndrome occurs secondary to the unopposed. Three cm protocols, each containing 30 patients, were created. Selective mr imaging approach for evaluation of patients. The local signs of cad include cervical pain, horners syndrome, and cranial nerve.
Horners syndrome was confirmed by either photographs or video showing distinct dilation lag or cocaine drop testing. High resolution mri sequences enable analysis of the arterial wall with. Horner syndrome is a set of symptoms affecting the eye which is thought to occur due to damage of the sympathetic nerve supply to the eye. Horner syndrome classically presents as an ipsilateral enophthalmos, blepharoptosis, pupillary miosis and facial anhydrosis due to disruption at some point of. Two patients with congenital horners syndrome are presented which demonstrated. Horners syndrome, carotid dissection, magnetic resonance imaging, computed tomography introduction horners syndrome hs is a combination of clinical signs, classically of ipsilateral ptosis, pupillary miosis, and facial anhydrosis table 1, secondary to the interruption of the oculosympathetic pathway. Lee, md et al introduction paragangliomas of the head and neck originate most commonly from the paraganglia within the carotid body, vagal nerve, middle ear, and jugular. Preganglionic horners syndrome without brainbrain stem symptoms protocol. The rationale behind this protocol is that a comprehensive mri from the head down to the thoracic t2 region will have higher sensitivity and higher specificity for pathology than multimodal imaging e. If a first or secondorder horner is present, a ct or mri of the chest to view pulmonary apex, mri head and neck with contrast, and possibly an mra of the aortic arch or cta of the head and. Therefore, a clear and efficient diagnostic imaging protocol has not yet been. This protocol has a number of advantages, including covering the. Imaging of cervical artery dissection sciencedirect.
If a patient has a fon hs without brain or brainstem signs, then the mri protocol should include cervical and upper thoracic spinal cord imaging. Horner syndrome results from an interruption of the oculosympathetic pathway. Horners syndrome and cranialnerve palsy occur in carotid artery dissections. Therefore, the presence of occult malignancy should be considered in any patient with shoulder or arm pain and new horner syndrome without a history of trauma. Horners syndrome, or oculosympathetic paresis, results from interruption of the sympathetic trunk innervation to the eye and presents typically with meiosis, ptosis and facial anhydrosis on the affected side. Mri protocols, mri planning, mri techniques and anatomy. Evaluation and neuroimaging of the horner syndrome. Horner syndrome is an uncommon but important clinical entity. Historic obsession in manual therapy with the vertebral artery and dissection in. Horners syndrome hs is a combination of clinical signs, classically of ipsilateral ptosis, pupillary miosis, and facial anhydrosis, secondary to the interruption of the oculosympathetic pathway. Horner syndrome kong 2007 clinical and experimental.
Pdf sivashakthi kanagalingam, neil r miller1department of ophthalmology. Emergent magnetic resonance imaging mri and magnetic resonance. Neuroimaging strategies for three types of horner syndrome with. Mri scan of neck and thorax because it has superiority over ct scan in. Physical therapy management intervention there are no specific protocols used by. Horner syndrome classically presents as an ipsilateral enophthalmos, blepharoptosis, pupillary miosis and facial anhydrosis due to disruption at some point of the oculosympathetic pathway ptosis is due to interruption of the sympathetic motor innervation of the superior tarsal muscle which is a small muscle composed of smooth muscle fibers intimately associated with the undersurface of. They had either documented causative diagnosis for hs or were idiopathic. Horners syndrome results from an interruption of the sympathetic nerve supply. Horner syndrome results from interruption of the oculosympathetic pathway and is. Pdf horner syndrome is an uncommon but important clinical entity, representing interruption of the sympathetic pathway to the eye and face. Spinal cord lesions that may cause a central horner syndrome include trauma, inflammatory or infectious myelitis, vascular malformation, demyelination, syrinx, syringomyelia, neoplasms, and infarction. Each patients pupils were photographed using a handtable 2.