Document Type

Conference Proceeding

Publication Date

5-2-2025

Abstract

Introduction: Horner Syndrome (HS) is a clinical syndrome characterized by the triad of unilateral ptosis, miosis, and anhidrosis. HS is caused by an interruption of the oculosympathetic nerve pathway, a three-neuron pathway. Common causes of Horner Syndrome include carotid dissection, stroke, trauma, tumors, cluster headaches, inflammation, and medical and surgical procedures. However, many cases of HS are also idiopathic. The standard workup of Horner Syndrome includes MRI of the brain, cervical spine, and upper thoracic spine and CT angiography of the circle of willis, aortic arch, and intracranial arteries. This case report will analyze an instance of Horner Syndrome that presented itself in a 43-yearold male after placement of a perineural catheter in the right neck. Case Description: The patient was a 43-year old male with a past medical history of GERD, morbid obesity (BMI=49), and a 12-pack-year smoking history. The patient presented with right arm pain after experiencing a fall at work. At the time, an X-ray showed an angulated and displaced right midshaft humeral fracture. Subsequently, open reduction and internal fixation (ORIF) of the right humeral shaft was completed with no surgical complications. To assist with postoperative pain, a perineural catheter was placed in the right neck, providing a low interscalene block. Three days after surgery, the patient presented to the emergency department complaining of blurry vision in his right eye, which was exacerbated when looking downwards. The patient was found to have ptosis and miosis of his right eye with full extraocular movements and no signs of focal cranial nerve deficits. These findings were consistent with right-sided Horner Syndrome. Non-contrast CT of the head and CT scan of the chest showed no acute intracranial processes or apical masses, respectively. CT angiography of the head and neck showed no signs of carotid artery dissection, large vessel occlusion, or flow limiting stenosis. Furthermore, CT angiography was negative for pulmonary embolism. Therefore, the patient was presumed to have right-sided Horner Syndrome due to foreign body placement as a result of the perineural catheter placed a few days prior. The perineural catheter was removed, and the patient’s HS completely resolved within twelve hours after the catheter removal. Discussion: The acute onset of Horner Syndrome indicates disruption of the oculosympathetic pathway. Therefore, a full-workup should be performed on patients with HS to investigate for any underlying or new life-threatening pathologies. Once severe and life-threatening causes of HS are ruled out, patient history, recent surgical procedures, and implanted foreign bodies should be evaluated as potential causes of Horner Syndrome. Furthermore, eliminating the underlying cause of HS may lead to resolution of symptoms. In this case, removal of the perineural catheter led to resolution of the patient’s Horner Syndrome within twelve hours.

Comments

American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter Resident and Medical Student Day, May 2, 2025, Troy, MI

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