Horners syndrom: Forskelle mellem versioner

Fra NeuroWiki
Spring til navigation Spring til søgning
Jannick Brennum (diskussion | bidrag)
Administratorer
3.064 rediger
Oprettede siden med ''''Horner's syndrom''' er en kombination af symptomer der skyldes påvirkning af grænsestrengen (truncus sympaticus) sympathetic trunk is damaged. ==Symptomer== Horners…'
 
Ingen redigeringsopsummering
 
(2 mellemliggende versioner af den samme bruger vises ikke)
Linje 16: Linje 16:


==Årsager==
==Årsager==
[[File:Horner's Syndrome and Autonomic innervation of the eye.svg|thumb|right|450px|Scheme showing sympathetic and parasympathetic innervation of the pupil and sites of a lesion in Horner's syndrome.]]
Horners syndrom er oftest erhvervet men kan også være medfødt (kongenit). De fleste årsager til Horners syndrom er relativt benigne så bør en af de mere alvorlige årsager altid overvejes = Pancoast tumor som er lokaliseret i lungeapeks og vokser ud og beskadiger græsnsestrengen
Horner syndrome is acquired as a result of disease but may also be [[congenital]] (inborn, associated with heterochromatic iris) or [[iatrogenic]] (caused by medical treatment). Although most causes are relatively benign, Horner syndrome may reflect serious disease in the neck or chest (such as a [[Pancoast tumor]] (tumor in the apex of the lung) or thyrocervical venous dilatation).


Causes can be divided according to the presence and location of anhidrosis:


* Central (anhidrosis = face, arm and trunk)
Årsager kan inddeles anatomisk efter om der er anhidrose og lokalisationen af denne:
** [[Syringomyelia]]
* Central (+anhidrose lokaliseret til ansigt,arm, trunkus)
** [[Multiple sclerosis]]
** Syringomyeli
** [[Encephalitis]]
** Multiple sklerose
** [[Brain tumors]]
** Encephalitis
** [[Lateral medullary syndrome]]
** Hjerne tumor
* [[Preganglionic]] (anhidrosis = face)
** Lateralt medullært syndrom
** [[Cervical rib]] traction on stellate ganglion
* Præganglionært (+anhidrosis lokaliseret til ansigt)
** [[Thyroid carcinoma]]
** Cervikalt ribben træk på ganglion stellatum
** [[Thyroidectomy]]
** Thyroidea cancer
** [[Goiter]]
** Thyroidectomi (Iatrogen)
** [[Bronchogenic carcinoma]] of the superior fissure ([[Pancoast tumor]]) on apex of lung
** Struma
** [[Klumpke paralysis]]
** Pancoast tumor  
** [[Physical trauma|Trauma]] - base of neck, usually blunt trauma, sometimes surgery.
** Klumpke paralyse (skade på plexus brachialis typisk traktions skade under fødsel)
** As a complication of [[tube thoracostomy]]
** Traume
** [[Thoracic aortic aneurysm]]
** Iatrogen ved thorax kirurgi
* [[Postganglionic]] (no anhidrosis)
** Thorakalt aorta aneurysme
** [[Cluster headache]] - combination termed Horton's headache
* Postganglionær uden anhidrose
** A Horner's syndrome may occur during a [[migraine]] attack and be relieved afterwards<ref>{{Cite journal|pmc=1298129|year=2000|last1=Laing|first1=C|last2=Thomas|first2=DJ|last3=Mathias|first3=CJ|last4=Unwin|first4=RJ|title=Headache, hypertension and Horner's syndrome|volume=93|issue=10|pages=535–536|journal=Journal of the Royal Society of Medicine|pmid=11064693}}.</ref>
** Horton's hovedpine
** [[Carotid artery dissection]]/[[carotid artery aneurysm]]
** Migræne
** [[Cavernous sinus thrombosis]]
** Carotis dissektion
** [[Middle ear infection]]
** Sinus Cavernosus Thrombose
* [[Sympathectomy]]
** Otitis Media
* [[Nerve block]]s, such as cervical plexus block, stellate ganglion or interscalene block
* Sympathectomi
* Nerve blokader


== Pathophysiology ==
Hvis patienten har anhydrosis på trunkus kun på den ene side uden samtidig tilstedeværelse af Horners syndrom så skyldes det skade på grænsestrengen lige under ganglion Stellatum.
Horner syndrome is due to a deficiency of [[Sympathetic nervous system|sympathetic]] activity.
The site of lesion to the sympathetic outflow is on the [[ipsilateral]] side of the symptoms.
The following are examples of conditions that cause the clinical appearance of Horner's syndrome:
*''First-order neuron disorder:'' Central lesions that involve the [[hypothalamospinal tract]] (e.g. transection of the cervical spinal cord).
*''Second-order neuron disorder:'' [[Preganglionic]] lesions (e.g. compression of the sympathetic chain by a lung tumor) that releases acetylcholine.
*''Third-order neuron disorder:'' [[Postganglionic]] lesions at the level of the internal carotid artery (e.g. a tumor in the [[cavernous sinus]] or a carotid artery dissection) that releases norepinephrine.
*''Partial Horner's syndrome'': In case of a third-neuron disorder, anhidrosis is limited to the middle part of the forehead or can be absent, resulting in a partial Horner's syndrome.<ref name="Lee">{{cite journal | author=Lee JH, Lee HK, Lee DH, Choi CG, Kim SJ, Suh DC | title=Neuroimaging strategies for three types of Horner syndrome with emphasis on anatomic location | journal=AJR Am J Roentgenol | year=2007 | pages=W74–81 | volume=188 | issue=1  | pmid=17179330 | doi=10.2214/AJR.05.1588}}</ref>


If someone has impaired sweating above the waist affecting only one side of the body, yet they do not have a clinically apparent Horner's syndrome, then the lesion is just below the [[stellate ganglion]] in the sympathetic chain.


==Diagnosis==
==Video om Horners syndrom==
[[File:Example of Horner's syndrome in a cat.jpg|thumb|Left-sided Horner's syndrome in a cat as a result of trauma, demonstrating miosis in left pupil.]]
{{#ev:youtube|7tCSPeVSApw|700|}}
Three tests are useful in confirming the presence and severity of Horner syndrome:
* Cocaine drop test: [[Cocaine]] eyedrops block the reuptake of post-ganglionic [[norepinephrine]] resulting in the [[mydriasis|dilation]] of a normal pupil from retention of norepinephrine in the synapse. However, in Horner's syndrome the lack of norepinephrine in the synaptic cleft causes [[mydriasis|mydriatic]] failure.  A more recently introduced approach that is more dependable and obviates the difficulties in obtaining cocaine is to apply the alpha-agonist [[apraclonidine]] to both eyes and observe the increased mydriatic effect (due to hypersensitivity) on the affected side of Horner syndrome (the opposite effect to what the cocaine test would produce in the presence of Horner's).{{Citation needed|date=July 2013}}
* [[p-Hydroxyamphetamine|Paredrine]] test: This test helps to localize the cause of the miosis. If the third order neuron (the last of three neurons in the pathway which ultimately discharges norepinephrine into the synaptic cleft) is intact, then the amphetamine causes neurotransmitter vesicle release, thus releasing norepinephrine into the synaptic cleft and resulting in robust mydriasis of the affected pupil. If the lesion itself is of the third order neuron, then the amphetamine will have no effect and the pupil remains constricted. There is no pharmacological test to differentiate between a first and second order neuron lesion.<ref name="Lee"/>
* Dilation lag test{{Clarify|date=July 2013}}
 
It is important to distinguish the [[ptosis (eyelid)|ptosis]] caused by Horner's syndrome from the ptosis caused by a lesion to the [[oculomotor nerve]]. In the former, the ptosis occurs with a constricted pupil (due to a loss of sympathetics to the eye), whereas in the latter, the ptosis occurs with a dilated pupil (due to a loss of innervation to the [[sphincter pupillae]]).  In a clinical setting, these two ptoses are fairly easy to distinguish.  In addition to the blown pupil in a CNIII ([[oculomotor nerve]]) lesion, this ptosis is much more severe, occasionally occluding the whole eye.  The ptosis of Horner syndrome can be quite mild or barely noticeable (partial ptosis).{{Citation needed|date=July 2013}}
 
When [[anisocoria]] occurs and the examiner is unsure whether the abnormal pupil is the constricted or dilated one, if a one-sided ptosis is present then the abnormally sized pupil can be presumed to be on the side of the ptosis.{{Citation needed|date=July 2013}}
 
== In children ==
The most common causes in young children are [[birth trauma]] and a type of cancer called [[neuroblastoma]].<ref name=":0">{{Cite book|title = Neuro-ophthalmology: Handbook of Clinical Neurology (Series Editors: Aminoff, Boller and Swaab)|url = https://books.google.com/books?id=5wgMetZtk0sC&pg=PA452|publisher = Elsevier|date = 2011-06-28|isbn = 9780702045479|first = Christopher|last = Kennard|first2 = R. John|last2 = Leigh|page = 452}}</ref>  The cause of about a third of cases in children is unknown.<ref name=":0" />
 
==History==
It is [[eponym|named after]] [[Johann Friedrich Horner]], the [[Switzerland|Swiss]] [[ophthalmology|ophthalmologist]] who first described the syndrome in 1869.<ref>{{cite journal | author=Horner JF | title=Über eine Form von Ptosis | journal=Klin Monatsbl Augenheilk | year=1869 | volume=7 | pages=193–8}}</ref><ref>{{WhoNamedIt|synd|1056}}</ref> Several others had previously described cases, but "Horner's syndrome" is most prevalent. In [[France]] and [[Italy]], [[Claude Bernard]] is also eponymized with the condition ("Claude Bernard-Horner syndrome").
 
==See also==
*[[Anisocoria]]
*[[Harlequin syndrome]]
 
==References==
{{reflist|2}}
 
{{Autonomic diseases}}
 
[[Category:Peripheral nervous system disorders]]
[[Category:Diseases of the eye and adnexa]]
[[Category:Syndromes]]




==Video om Horners syndrom==
--[[Bruger:Jannick Brennum|Jannick Brennum]] 28. dec 2015, 09:46 (UTC)
{{#ev:youtube|7tCSPeVSApw|700|}}
[[Kategori: Neurologiske undersøgelser & fund]]

Nuværende version fra 28. dec. 2015, 11:54

Horner's syndrom er en kombination af symptomer der skyldes påvirkning af grænsestrengen (truncus sympaticus) sympathetic trunk is damaged.


Symptomer

Horners syndrom er karakteriseret af ensidige fund og symptomer i form af:

  • Miosis (pupil kontraktion)
  • Ptose partiel (hængende øjenlåg)
  • Anhidrose (nedsat svedproduktion lokalt)
  • Enoftalmus (indsunket øje - ikke et obligatorisk fund)

Anatomi

Den sympatiske innervation af øjet er en 3-neuron kæde startende:

  • 1. Centrale sympatiske fibre fra del posterolaterale del af hypothalamus descenderer ukrydset til C8-Th2 niveau i medulla spinalis
  • 2. Præganglionære fibre træder ud fra Th1 niveau træder ind i grænsestrengen og askenderer til ganglion cervikale på niveau C3-4 ud for carotis bifurkaturen
  • 3. Postganglionære fibre fra ganglion cervikale danner netværk omkring a. carotis interna og fortsætter med denne gennem sinus cavernosus

Årsager

Horners syndrom er oftest erhvervet men kan også være medfødt (kongenit). De fleste årsager til Horners syndrom er relativt benigne så bør en af de mere alvorlige årsager altid overvejes = Pancoast tumor som er lokaliseret i lungeapeks og vokser ud og beskadiger græsnsestrengen


Årsager kan inddeles anatomisk efter om der er anhidrose og lokalisationen af denne:

  • Central (+anhidrose lokaliseret til ansigt,arm, trunkus)
    • Syringomyeli
    • Multiple sklerose
    • Encephalitis
    • Hjerne tumor
    • Lateralt medullært syndrom
  • Præganglionært (+anhidrosis lokaliseret til ansigt)
    • Cervikalt ribben træk på ganglion stellatum
    • Thyroidea cancer
    • Thyroidectomi (Iatrogen)
    • Struma
    • Pancoast tumor
    • Klumpke paralyse (skade på plexus brachialis typisk traktions skade under fødsel)
    • Traume
    • Iatrogen ved thorax kirurgi
    • Thorakalt aorta aneurysme
  • Postganglionær uden anhidrose
    • Horton's hovedpine
    • Migræne
    • Carotis dissektion
    • Sinus Cavernosus Thrombose
    • Otitis Media
  • Sympathectomi
  • Nerve blokader

Hvis patienten har anhydrosis på trunkus kun på den ene side uden samtidig tilstedeværelse af Horners syndrom så skyldes det skade på grænsestrengen lige under ganglion Stellatum.


Video om Horners syndrom

{{#ev:youtube|7tCSPeVSApw|700|}}


--Jannick Brennum 28. dec 2015, 09:46 (UTC)

Hentet fra "https://neurowiki.dk/index.php?title=Horners_syndrom&oldid=6465"