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Horner syndrome

icanis

Synonym(s): Claude Bernard-Horner syndrome; Horner's syndrome


Introduction

  • Common unilateral neurological disorder of eye - can sometimes be bilateral.
  • Cause: most common cause is idiopathic Horner syndrome - potentially lesion anywhere along the sympathetic pathway to the eye (brainstem, cervical spinal cord, T1-T3 spinal cord, brachial plexus, intrathoracic, vagosympathetic trunk, middle ear, retrobular).
  • Signs: ptosis upper eyelid, miosis, enophthalmos, protrusion of third eyelid (due to enophthalmos and nictitans muscle relaxation in cats), conjunctival hyperemia in some animals.
  • Diagnosis: sometimes can identify location of injury pharmacologically, more usually by other associated clinical signs.
  • Treatment: specific treatment for underlying disease if it can be ascertained; clinical signs can often be improved with topical phenylephrine.
  • Prognosis: can recover over protracted period, depending on site and nature of lesion.
Print off the owner syndrome Horner syndrome to give to your client.Follow the diagnostic tree for Horner Syndrome.

Pathogenesis

Etiology

Predisposing factors

General
  • Dogs with a tendency to develop spinal cord and middle ear disease are at risk.

Pathophysiology

  • Pathological change at one of several sites → failure of sympathetic nerve supply to eye and surrounding structures → loss of smooth muscle tone → clinical signs.
    • First order: hypothalmus to T1-T3 spinal cord lesions.
    • Second order: thoracic sympathetic trunk to cranial cervical ganglion lesions.
    • Third order: post-ganglionic fibers arising at cranial cervical ganglion rostrally up to the eye.

Timecourse

  • Slow recovery over many months depending on etiology and treatment.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Simpson K M, Williams D L, Cherubini G B (2015) Neuropharmacological lesion localisation in idiopathic Horner's syndrome in Golden retrievers and dogs of other breeds. Vet Ophthamol 18, 1-5 PubMed.
  • Spivak R E, Elkins A D, Moore G E et al (2013) Postoperative complications following TECA-LBO in the dog and cat. JAAHA 49, 160-168 PubMed.
  • Boydell P (2000) Idiopathic Horner syndrome in the golden retriever. J Neuroophthalmol 20, 288-290 PubMed.
  • Boydell P & Brogan N (2000) Horner's syndrome associated with Neospora infection. JSAP 41 (12), 571-572 PubMed.
  • Boydell I P (1998) Horner's syndrome in a puppy. JSAP 39 (9), 448-9 PubMed.

Other sources of information

  • Garosi L, Lowrie M (2014) Neuro-ophthalmology. In: BSAVA Manual of Ophthalmology. 3rd edn. Gould D & McLellan G (eds). BSAVA.
  • Gelatt K N (1999)Veterinary ophthalmology.3rd Edn. Williams & Wilkins.

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