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Vesna V. Brinar - One of the best experts on this subject based on the ideXlab platform.
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Horner Syndrome due to jugular vein thrombosis lemierre Syndrome
Case Reports, 2009Co-Authors: Mario Habek, Damir Petravic, David Ozretić, Vesna V. BrinarAbstract:A 60-year-old patient was referred to our Department for evaluation of anisocoria. His neurological examination revealed Horner Syndrome on the right side. The rest of the examination was normal. Six months before, he had acute tonsillitis: throat cultures revealed a polymicrobial flora consisting of both aerobic and anaerobic bacteria, which was treated with 1 600 000 international units of bipenicillin intramuscularly for 10 days. On admission, he had a normal complete blood count, C-reactive protein and chest X-ray. Throat and blood cultures were normal. Brain multi-sliced CT was normal. Colour Doppler of carotid arteries revealed a normal flow through both the internal carotid arteries; however, the flow through the right jugular vein could not be recorded. Brain MRI and MR venography records are shown in figure 1. Neck ultrasound revealed a hypoechogenic nodule in the right submandibular gland (1.8 × 0.4 × 1.9 cm), whereas cytological analysis showed numerous neutrophils and cell debris, which was consistent with pus. Numerous enlarged neck lymph nodes were present bilaterally. Treatment with metronidazole and cefuroxime axetil was initiated, with good recovery. Despite therapy, Horner Syndrome persisted. Figure 1 (A) Neck MRI, T2-weighted sequences showing hyperintensity with mild distention of the right jugular vein (small white arrow) compared with the lack of signal in the left jugular vein representing normal flow (large white arrow). (B) MR venography showing ... The classic presentation of Lemierre Syndrome includes primary oropharyngeal, tonsillar or peritonsillar inflammation with later development of sepsis, internal jugular vein thrombosis and septic emboli, and this is caused by Fusobacterium necrophorum. As a consequence of widespread antibiotic use for pharyngeal infections, the typical course of the disease has changed, so a high grade of clinical suspicion is needed to establish an accurate diagnosis.1 The patient showed no signs of infection; his only clinical presentation was right-sided Horner Syndrome. As the most feared cause of post-ganglionic Horner Syndrome is carotid artery dissection, Colour Doppler of the carotid arteries was performed to reveal that there was no flow through the right jugular vein. Subsequent investigations led us to the correct diagnosis of jugular vein thrombosis due to Lemierre Syndrome. As the patient had already received antibiotic therapy, the clinical picture of Lemierre Syndrome was not fully developed, and blood and throat cultures did not reveal Fusobacterium necrophorum. Although post-ganglionic Horner Syndrome is a well-recognised sign of a carotid dissection, it may also be an important sign of the adjacent vena cava pathology.
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Horner Syndrome due to jugular vein thrombosis lemierre Syndrome
Journal of Neurology Neurosurgery and Psychiatry, 2008Co-Authors: Mario Habek, Damir Petravic, David Ozretic, Vesna V. BrinarAbstract:A 60-year-old patient was referred to our Department for evaluation of anisocoria. His neurological examination revealed Horner Syndrome on the right side. The rest of the examination was normal. Six months before, he had acute tonsillitis: throat cultures revealed a polymicrobial flora consisting of both aerobic and anaerobic bacteria, which was treated with 1 600 000 international units of bipenicillin intramuscularly for 10 days. On admission, he had a normal complete blood count, C-reactive protein and chest X-ray. Throat and blood cultures were normal. Brain multi-sliced …
Mario Habek - One of the best experts on this subject based on the ideXlab platform.
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Beware of "old" Horner Syndrome.
Optometry and vision science : official publication of the American Academy of Optometry, 2012Co-Authors: Ivan Adamec, Vesna Matijević, Goran Pavliša, Ivana Zadro, Mario HabekAbstract:PURPOSE Chronic Horner Syndrome is a rare clinical condition, the etiology of which often remains undiscovered. A patient is presented with an 8-year history of Horner Syndrome who was diagnosed with multiple cervical artery dissections. CASE REPORT A 42-year-old woman presented to our emergency department with a severe occipital headache that woke her up from sleep 3 days earlier. She had a history of headaches and recalled one in particular dating back to 2003. At that time, she sought medical attention at general practitioner's office because of the terrible headache and a noticeable disparity of her pupils. She was told that she had miosis of the right pupil. The examination conducted in 2011 revealed Horner Syndrome with right miosis and ptosis. A four-vessel cerebral angiography revealed an occlusion of the right internal carotid artery. The morphology of stenosis and pseudoaneurysm of C1 segment of left internal carotid artery, as well as a pseudoaneurysm of V3/V4 junction of left vertebral artery indicated a probable dissective etiology. CONCLUSIONS This case illustrates that Horner Syndrome with a chronic presentation can be as potentially dangerous as its acute counterpart and should be judiciously investigated.
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Horner Syndrome due to jugular vein thrombosis lemierre Syndrome
Case Reports, 2009Co-Authors: Mario Habek, Damir Petravic, David Ozretić, Vesna V. BrinarAbstract:A 60-year-old patient was referred to our Department for evaluation of anisocoria. His neurological examination revealed Horner Syndrome on the right side. The rest of the examination was normal. Six months before, he had acute tonsillitis: throat cultures revealed a polymicrobial flora consisting of both aerobic and anaerobic bacteria, which was treated with 1 600 000 international units of bipenicillin intramuscularly for 10 days. On admission, he had a normal complete blood count, C-reactive protein and chest X-ray. Throat and blood cultures were normal. Brain multi-sliced CT was normal. Colour Doppler of carotid arteries revealed a normal flow through both the internal carotid arteries; however, the flow through the right jugular vein could not be recorded. Brain MRI and MR venography records are shown in figure 1. Neck ultrasound revealed a hypoechogenic nodule in the right submandibular gland (1.8 × 0.4 × 1.9 cm), whereas cytological analysis showed numerous neutrophils and cell debris, which was consistent with pus. Numerous enlarged neck lymph nodes were present bilaterally. Treatment with metronidazole and cefuroxime axetil was initiated, with good recovery. Despite therapy, Horner Syndrome persisted. Figure 1 (A) Neck MRI, T2-weighted sequences showing hyperintensity with mild distention of the right jugular vein (small white arrow) compared with the lack of signal in the left jugular vein representing normal flow (large white arrow). (B) MR venography showing ... The classic presentation of Lemierre Syndrome includes primary oropharyngeal, tonsillar or peritonsillar inflammation with later development of sepsis, internal jugular vein thrombosis and septic emboli, and this is caused by Fusobacterium necrophorum. As a consequence of widespread antibiotic use for pharyngeal infections, the typical course of the disease has changed, so a high grade of clinical suspicion is needed to establish an accurate diagnosis.1 The patient showed no signs of infection; his only clinical presentation was right-sided Horner Syndrome. As the most feared cause of post-ganglionic Horner Syndrome is carotid artery dissection, Colour Doppler of the carotid arteries was performed to reveal that there was no flow through the right jugular vein. Subsequent investigations led us to the correct diagnosis of jugular vein thrombosis due to Lemierre Syndrome. As the patient had already received antibiotic therapy, the clinical picture of Lemierre Syndrome was not fully developed, and blood and throat cultures did not reveal Fusobacterium necrophorum. Although post-ganglionic Horner Syndrome is a well-recognised sign of a carotid dissection, it may also be an important sign of the adjacent vena cava pathology.
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Horner Syndrome due to jugular vein thrombosis lemierre Syndrome
Journal of Neurology Neurosurgery and Psychiatry, 2008Co-Authors: Mario Habek, Damir Petravic, David Ozretic, Vesna V. BrinarAbstract:A 60-year-old patient was referred to our Department for evaluation of anisocoria. His neurological examination revealed Horner Syndrome on the right side. The rest of the examination was normal. Six months before, he had acute tonsillitis: throat cultures revealed a polymicrobial flora consisting of both aerobic and anaerobic bacteria, which was treated with 1 600 000 international units of bipenicillin intramuscularly for 10 days. On admission, he had a normal complete blood count, C-reactive protein and chest X-ray. Throat and blood cultures were normal. Brain multi-sliced …
Daniel T Altman - One of the best experts on this subject based on the ideXlab platform.
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high thoracic disc herniation causing Horner Syndrome with the intraoperative finding of conjoined nerve root compression a case report
Journal of Bone and Joint Surgery American Volume, 2017Co-Authors: Amit K Bhandutia, Zachary Zuzek, Matthew J Schessler, Nestor D Tomycz, Daniel T AltmanAbstract:Case: A 29-year-old man presented with right medial arm pain with paresthesia, as well as right-sided ptosis, miosis, and anhidrosis. Magnetic resonance imaging revealed a right paracentral disc herniation at the T1-T2 level. The patient underwent a hemilaminectomy with a medial facetectomy through a posterolateral approach to the T1-T2 disc space, followed by a discectomy. Intraoperative findings were notable for a conjoined nerve root. Conclusion: Although high thoracic disc herniation is rare, its diagnosis should be considered when patients present with radicular arm pain and Horner Syndrome. A high index of suspicion should be maintained for nerve root anomalies to limit iatrogenic injury and to ensure successful decompression.
Andrew G Lee - One of the best experts on this subject based on the ideXlab platform.
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Postoperative Horner Syndrome After Lung Transplantation.
Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society, 2019Co-Authors: Aroucha Vickers, T. Kaleekal, Hilary A. Beaver, Andrew G LeeAbstract:Background Horner Syndrome arises from a disruption along the oculosympathetic efferent chain and can be caused by a variety of pathological and iatrogenic etiologies. We present 3 cases of postoperative Horner Syndrome after bilateral lung transplantation. Methods The electronic health records of 3 patients with iatrogenic Horner Syndrome after lung transplantation were examined, including notes from each patient's medical history, operative and postoperative records, and ophthalmology consultation results. A literature review was performed. Results All 3 of our patients displayed anisocoria and ptosis, symptoms consistent with Horner Syndrome, and the patients from Cases 1 and 2 showed reversal of anisocoria after an application of topical apraclonidine. Conclusions Ophthalmologists should be aware of the risk of Horner Syndrome after lung transplantation.
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evaluation and neuroimaging of the Horner Syndrome
Canadian Journal of Ophthalmology-journal Canadien D Ophtalmologie, 2015Co-Authors: Ying Chen, Michael L Morgan, Angelina Espino Barros Palau, Sushma Yalamanchili, Andrew G LeeAbstract:Abstract Objective To define the efficacy, safety, and cost-effectiveness of a single centre’s approach to evaluating Horner Syndrome (HS) including a simplified single neuroimaging protocol. Design Case series study. Participants Medical records of 34 patients diagnosed with HS at Houston Methodist Hospital (HMH) were reviewed after obtaining Institutional Review Board approval. Methods A retrospective chart review was performed for all patients presenting with the diagnosis of HS at the HMH from January 2010 to November 2013. All patients had diagnostic imaging with contrast-enhanced brain magnetic resonance imaging (MRI) extending to the T2 level in the chest. They had either documented causative diagnosis for HS or were “idiopathic.” Efficacy and cost-effectiveness of the proposed neuroimaging technique were analyzed compared with other recommended protocols. Results We initially reviewed 34 charts with presumed diagnosis of HS; 27 charts were included in the analysis. The average age of patients was 46.6 years. Eleven patients (41%) had a final diagnosis of HS secondary to a proven cause, and 16 patients (59%) were diagnosed as “idiopathic.” Ten patients (63%) in the idiopathic group had follow-up, and none of those with follow-up had an alternative cause. The estimated cost of our recommended MRI protocol was US$667.76 without magnetic resonance angiography (MRA) or US$1501.71 with MRA. Conclusions A single contrast-enhanced brain MRI extending to the T2 level in the chest is an effective and simple means of ruling out life-threatening and other causative factors of HS. Compared with previous imaging recommendations, this proposed protocol may be simpler for clinicians to use and more cost-effective.
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Horner Syndrome following a selective cervical nerve root block
Journal of Neuro-ophthalmology, 2011Co-Authors: Kevin Kaplowitz, Andrew G LeeAbstract:Abstract:A 31-year-old man with cervical degenerative disc disease was seen at an outside institution for a right selective nerve root block at C7. Following the procedure, he had right ptosis and miosis. Pharmacologic testing confirmed a right Horner Syndrome. MRI and MRA showed no arterial dissect
Winying Chen - One of the best experts on this subject based on the ideXlab platform.
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efficacy of apraclonidine 0 5 in the diagnosis of Horner Syndrome in pediatric patients under low or high illumination
American Journal of Ophthalmology, 2006Co-Authors: Poliang Chen, Chihhsien Hsiao, Jianntorng Chen, Winying ChenAbstract:Purpose To evaluate the efficacy and safety of apraclonidine 0.5% in the diagnosis of Horner Syndrome in pediatric patients. Design Prospective, interventional case series. Methods Ten pediatric patients with a diagnosis of Horner Syndrome and 10 age-matched controls with physiologic anisocoria underwent pharmacological testing with apraclonidine. The difference between the pupil diameters of both eyes under low (room light off) and high (room light on) ambient illumination before and one hour after apraclonidine was instilled was recorded. Any adverse effects during the examination or reported by the patient's parents were recorded. Results The mean differences in pupil diameters before and after apraclonidine testing in the Horner Syndrome group were −2.05 mm and 0.97 mm, respectively, under low illumination ( P = .0049) and −1.48 mm and 1.1 mm, respectively, under high illumination ( P = .0051). Three patients with Horner Syndrome showed positive values (reversal of anisocoria) only under high ambient illumination, but not under low illumination. There was no statistical difference in the mean differences in pupil diameter before and after apraclonidine testing in the control group. Conjunctival hyperemia was noted in two patients with Horner Syndrome and in three patients in the control group. No systemic adverse effects were noted during the examination or were reported by patients' parents. Conclusions The application of apraclonidine in pediatric patients is safe and effective in the diagnosis of Horner Syndrome. The reversal of anisocoria was more obvious under high (room light on) ambient illumination.