Abstract

P 163

Horner´s syndrome as an ophthalmologic emergency

Munir Marcel Keilani, Susanne  Pitz, Norbert Pfeiffer, Giulia Renieri
Universitäts-Augenklinik Mainz

Objective
Horner´s syndrome results from disruption of the sympathetic pathways and represents with more than 25% a frequent symptom of a dissection of the cervical internal carotid artery. Clinically its manifestation could be discreet. However, in some cases an early diagnosis of Horner´s syndrome can prevent cerebral ischemia or embolic complications.
Methods
We present the case of a 47-year-old otherwise healthy male patient with sudden onset of anisocoria and unilateral discreet ptosis of the right eye. He complained about mild tiredness, dizziness and cluster headache. Anamnestically, a cervical myelitis in 2002 had caused paresthesia in extremity and thorax. Due to neck pain with radiculopathy the patient had received a couple of chiropractic treatments some years ago. The immediately-arranged computed tomography plus angiography of head and neck revealed a dissection of the distal section of the internal carotid artery. The patient was transferred expeditiously to the stroke unit and treated conservatively using heparinisation.
Results
Our case report as well as current literature highlight that internal carotid artery dissection as common cause of Horner´s syndrome is under-recognized and can easily be missed, although the spontaneous dissection of the internal carotid artery might lead to embolic complications with lethal ending. The risk of serious consequences is highest in the first couple of days after a spontaneous dissection. The investigation of choice is a magnetic resonance imaging and angiography scan of head and neck.
Conclusions
The urgent examination of Horner´s syndrome with extensive neuroradiological methods inclusive the angiography of the brain vessels is always required if the Horner´s triad is accompanied by atypical features. Apart from the oculosympathetic paresis the patient might complain about head, facial or neck pain, tinnitus, dysarthria, dysphagia, paralysis of tongue or monocular visual impairment. The Horner´s syndrome should also be considered as an emergency if children or middle-aged otherwise healthy patients spontaneously suffer from it. Anamnestically reported trivial traumata, a recent history of a respiratory tract infection or a chiropractic manipulation of head or neck in the past are further risk factors of a vascular dissection which should be taken into consideration as well. With these circumstances in mind, prompt treatment could be initiated to prevent ocular or cerebral ischemia.

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