Claude Bernard-Horner, syndrome
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Triad: ptosis, miosis and enophthalmos (or unilateral facial anhidrosis ).
This ocular sympathetic paralysis is due to a permanent or temporary interruption of the neural pathway connecting the hypothalamus to the eye. This neural pathway includes neurons at the level of the postero-lateral nucleus of the hypothalamus linked to the cilio-spinal centre of Budge-Waller located in the spinal cord between C8 and T2. The later is connected to the superior cervical sympathetic ganglion via the stellate ganglion; the neural fibers innervating the eye and the sweat glands of the ipsilateral lower part of the face come from the superior cervical ganglion.
The main causes of Claude Bernard-Horner syndrome can be:
- congenital: rare
- compression by a benign or malignant tumor: cervical neuroblastoma, lymphoma...
- local trauma: direct injury or compression by a hematoma following the (attempted) insertion of a catheter in the internal jugular vein
- locoregional anesthesia: interscalenic block, block of the stellate ganglion, unilateral cephalic diffusion of an epidural block
- compression by an apical chest drain, too close to the stellate ganglion
Anesthetic implications:
depending on the cause: decrease the dose of local anesthetics in case of extended epidural block; check for compressive hematoma when a jugular central line has been inserted; mobilization of apical chest drain.
References :
- Lazar I, Cavari Y, Rosenberg E, Knyazer B.
Horner’s syndrome in patients admitted to the paediatric intensive care unit: epidemiology, diagnosis and clinical practice.
Anaesth Intensive Care 2013; 41: 20-3.
- Aronson LA, Parker GC, Valley R, Norfleet EA.
Acute Horner syndrome due to thoracic epidural analgesia in a paediatric patient.
Paediatr Anaesth 2000; 10: 89-91.
Updated: October 2019