What Leads To Horner’s Syndrome & Can It Be Cured?

Horner syndrome is a medical condition that is characterized by the dysfunction of the sympathetic system supplying to the eye and face and sometimes neck region also. There is a typical presentation of the condition in the form of miosis, ptosis, anhidrosis and heterochromia iridis. There can be a variety of causes that can lead to horner’s syndrome and are classified into first, second and third-order of lesions depending upon the level at which the interference has come in the pathway.

What Leads To Horner’s Syndrome?

Horner syndrome can be congenital or acquired depending upon the malformations causing it. The causes responsible can range from a very benign vascular headache to an intracranial malignancy progressing rapidly. Postganglionic sympathetic involvement usually is located intracranially or intraocularly and has usually a primary benign cause responsible for it. Whereas in the case of preganglionic sympathetic involvement the cause is usually a dangerous one like intracranial malignancy.

Depending upon the order of lesion, the first order horner’s syndrome can be caused due to congenital conditions like Arnold Chiari malformation, pituitary tumors, basal skull tumors and can be caused due to acquired reasons like syringomyelia, intracerebral hemorrhage especially in the pontine region, demyelinating disorders like multiple sclerosis, cerebrovascular accidents, or neck trauma also.

Second-order of lesion in the horner syndrome is caused due to congenital causes like cervical rib, lesions of subclavian artery, congenital tumors like neuroblastoma, or can be caused due to acquired causes like tumor in the thoracic cavity or apex of lung for e.g. Pancoast tumor, traumatic surgeries in the neck region like thyroidectomy, radical neck dissection, Central line catheterization, chest tube placement, radiofrequency ablation of the tonsils or medical conditions like aneurysm or dissection of aorta, mandibular abscess formation, middle ear inflammation known as acute otitis media, etc.(1)

The third order of lesion in horner’s syndrome is caused congenitally very rarely and most of its causes are acquired like a raeder syndrome, carotid artery dissection, cluster headache, fistula formation between the internal carotid artery and cavernous sinus due to trauma or medical conditions like viral infection for e.g. herpes zoster, etc.

Can Horner’s Syndrome Be Cured?

Horner syndrome is a clinical presentation of the underlying causes which if get cured then the symptoms will also subside unless the damage incurred to the sympathetic supply is permanent. It usually is caused due to benign causes which can be cured medically and till the symptoms subside, symptomatic treatment can also be given. But the absolute cure rate depends largely upon the cause of the syndrome and complete treatment of the underlying disease. Many of the malignant causes are also responsible for the horner’s syndrome and are not treatable leading to poor prognosis in those cases.

Surgical treatment is also available for some of the causes as well as symptoms of horner’s syndrome which can be used appropriately based upon the requirement of the patient and understanding of the physician. Unnecessary treatment of the symptoms without eradicating the root cause will not help the patient in the longer run.

Conclusion

Horner syndrome is just a clinical presentation that can occur from a variety of causes ranging from congenital and purely hereditary disorders to acquired and trauma-based conditions. Usually, the causes responsible for horner syndrome are benign in nature like a vascular headache but sometimes there can also be malignant causes responsible for it like metastatic lymphadenopathy, Pancoast tumor, intracranial malignancies, etc. The most common association with horner’s syndrome is cluster headache or cluster migraine. The order of lesion responsible for horner syndrome can be divided into first, second and third orders depending upon the level of lesions and the fibers getting affected by it. The presentation at the symptoms of different levels also varies which helps in the clinical diagnosis of the condition. The cure rate of the horner syndrome largely depends upon the cause and is variable due to its widespread etiology.

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