Database : MEDLINE
Search on : posterior and cervical and sympathetic and syndrome [Words]
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[PMID]: 29445946
[Au] Autor:Prezerakos GK; Sayal P; Kourliouros A; Pericleous P; Ladas G; Casey A
[Ad] Address:Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. gprezerakos@gmail.com.
[Ti] Title:Paravertebral tumours of the cervicothoracic junction extending into the mediastinum: surgical strategies in a no man's land.
[So] Source:Eur Spine J;, 2018 Feb 14.
[Is] ISSN:1432-0932
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: Cervicothoracic paravertebral neoplasms extending into the mediastinum pose a surgical challenge due the complex regional anatomy, their biological nature, rarity and surgeon's unfamiliarity with the region. We aim to define a surgical access framework addressing the aforementioned complexities whilst achieving oncological clearance. METHODS: We carried out a retrospective review of 28 consecutive patients operated in two tertiary referral centres between 1998 and 2015. Pathology was located paravertebrally from C6 to T4 with superior mediastinum invasion. Patients were operated jointly by a spinal and a thoracic surgeon. RESULTS: Tumours were classified according to subclavian fossa involvement as anteromedial, anterolateral and posterior and according to histology in benign nerve sheath tumour group (n = 10) and malignant bone or soft tissue tumours (n = 18). Three surgical routes were utilised: (1) median sternotomy (n = 11), (2) anterior cervical transsternal approach (n = 7) and (3) high posterolateral thoracotomy (n = 10). Resection was en bloc with wide margins in 22 cases, marginally complete in 3 and incomplete in 3. Complications included Horner's syndrome (n = 3), infection (n = 2) and transient neurological deficit (n = 4). In the nerve sheath tumour group, no recurrence or reoperation took place with a median follow-up of 4.5 years. In the malignant bone and soft tissue group, 96% of the patients were alive at 1 year, 67% at 2 years and 33% at 5 years. No vascular injuries or operative related deaths were observed. CONCLUSIONS: Classification of cervicothoracic paravertebral neoplasms with mediastinal extension according to the relationship with the subclavicular fossa and dual speciality involvement allows for a structured surgical approach and provides minimal morbidity/maximum resection and satisfactory oncological outcomes. These slides can be retrieved under Electronic Supplementary Material.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180215
[Lr] Last revision date:180215
[St] Status:Publisher
[do] DOI:10.1007/s00586-018-5512-5

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[PMID]: 29357327
[Au] Autor:Park C; Suh CH; Shin JE; Baek JH
[Ad] Address:Department of Radiology, Namwon Medical Center, Republic of Korea; Department of Radiology, Chonnam National University Hospital, Republic of Korea.
[Ti] Title:Characteristics of the Middle Cervical Sympathetic Ganglion: A Systematic Review and Meta-Analysis.
[So] Source:Pain Physician;21(1):9-18, 2018 Jan.
[Is] ISSN:2150-1149
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Understanding the characteristics of the middle cervical sympathetic ganglion (MCSG) may minimize procedure-related complications and maximize efficacy during surgery or ultrasound (US)-guided procedures. The location and detection rate of the MCSG were variable in small population studies. Therefore, a large population study or meta-analysis could give more information about the MCSG. OBJECTIVES: We aim to review the published literature and evaluate the anatomical features of the MCSG, including the detection rate, location, size, and a normal variation, and to review the clinical relevance of MCSG for procedures including, US-guided ganglion block, ethanol ablation (EA), or radiofrequency ablation (RFA). STUDY DESIGN: A systematic review and meta-analysis. The Ovid-MEDLINE and EMBASE databases were searched to find the detection rate, location, and other characteristics of the MCSG. SETTING: The pooled proportions for the detection rate of the MCSG were assessed using the DerSimonian-Laird random-effects model. METHODS: Heterogeneity among the studies was determined using a chi-square analysis for the pooled estimates and inconsistency index (I²). In order to reduce the heterogeneity, sensitivity analyses were performed. RESULTS: A review of 542 studies identified 8 eligible studies, with 273 MCSGs included in the meta-analysis. The pooled proportion for the detection rate of the MCSG was 50.4% (95% confidence interval [CI], 34.5 - 66.4%). Considerable heterogeneity among the studies was observed (I² = 94.9%). In the sensitivity analysis, when excluding one study, heterogeneity was reduced with a recalculated pooled proportion of 44.2% (95% CI, 32.1 - 56.2%; I² = 86.0%). The location of the MCSG is usually posterior to the carotid sheath and anterior to the longus colli muscle at the level of the C3 - C7 vertebrae. There was a variant where the cervical sympathetic trunk was located at the posterior wall of the carotid sheath and was adherent to the sheath. The size of the MCSG is as follows: the width, length, and height ranges were 3.8 - 6.3 mm, 6.3 - 10.5 mm, and 1.7 - 2.1 mm, respectively. A specific type of MCSG, referred to as the "double middle cervical ganglion", consisting of 2 ganglia, was demonstrated in 3 studies with a detection rate of 2.9 - 10%. LIMITATIONS: This meta-analysis included a relatively small number of studies. Significant heterogeneity was also present in the detection rate of MCSG in these studies. There was a lack of concentrated information about the MCSG, because the majority of the included studies focused on the entire cervical sympathetic chain, not only MCSG primarily. Improving complication rates might be limited due to the approximate 50% detection rate. CONCLUSION: Understanding the characteristics and variations of the MCSG could minimize complications and maximize efficacy during surgery and US-guided procedures. KEY WORDS: Middle cervical sympathetic ganglion, cervical sympathetic trunk, cervical sympathetic chain, ultrasound, nerve block, ethanol ablation, radiofrequency ablation, thyroid, Horner syndrome, meta-analysis.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180122
[Lr] Last revision date:180122
[St] Status:In-Data-Review

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[PMID]: 28782691
[Au] Autor:Garces J; Mathkour M; Scullen T; Kahn L; Biro E; Pham A; Sulaiman OAR; Smith R; Bui CJ
[Ad] Address:Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA; Department of Neurosurgery, Tulane University, New Orleans, Louisiana, USA.
[Ti] Title:First Case of Autonomic Dysreflexia Following Elective Lower Thoracic Spinal Cord Transection in a Spina Bifida Adult.
[So] Source:World Neurosurg;, 2017 Aug 03.
[Is] ISSN:1878-8769
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Spinal cord transection is a radical but effective treatment for highly selective cases of symptomatic spinal retethering in paraplegic spina bifida patients. Autonomic dysreflexia (AD) is a potentially life-threatening syndrome involving a dysregulated sympathetic discharge reflex commonly seen following cervical and high thoracic spinal cord injury, leading to a disconnect between autonomic pathways above and below the lesion that can lead to severe complications including uncontrolled hypertension, bradycardia, stroke, and potentially death. Herein we present a case in which a paraplegic spina bifida patient presenting with symptomatic spinal retethering experienced autonomic dysreflexia following an elective spinal cord transection. CASE DESCRIPTION: A 51-year-old male with a history of complex spina bifida presented with an active cerebrospinal fluid leak. Physical examination revealed a thin covering of abnormal epidermis over the large placode. Magnetic resonance imaging revealed a large myelomeningocele defect with posterior element defects spanning from L2 to the sacrum with evidence of tethering. The patient underwent an intradural transection of the spinal cord with a "blind-pouch" closure of the dura at the level of T12/L1. Postoperatively, the patient developed intermittent episodes of hypertension, bradycardia, headaches, altered mental status, severe perspiration, and red flushing of the upper torso, face, and arms. The diagnosis of AD was made clinically and managed with a positive response to a combination of beta- and alpha-blockade along with patient education on avoidance of common AD triggers. At 5-year follow-up the patient has continued to do well on medication. CONCLUSION: This case highlights a potential major side effect from elective transection of the spinal cord. If unrecognized and untreated, AD can cause significant distress and morbidity. We hope this first case report serves to supplement existing data and aid in future surgical and medical decision-making.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1708
[Cu] Class update date: 171023
[Lr] Last revision date:171023
[St] Status:Publisher

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[PMID]: 28243349
[Au] Autor:Saeed O; Khan AA; Herial NA; Aytac E; Qureshi AI
[Ad] Address:Zeenat Qureshi Stroke Institute, St. Cloud, MN 56303, USA.
[Ti] Title:Percutaneous Cervical Sympathetic Block for Pain Control after Internal Carotid Artery Dissection. A Report of Two Cases.
[So] Source:J Vasc Interv Neurol;9(3):36-40, 2017 Jan.
[Is] ISSN:1941-5893
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Medical treatment of cranio-cervical pain can be suboptimal in patients with internal carotid artery (ICA) dissection. We report the use of cervical sympathetic block for treatment of pain in two patients with ICA dissection. CASE REPORTS: A 58-year-old man and a 43-year-old woman presented with severe cranio-cervical pain associated with left and right ICA dissection confirmed by magnetic resonance imaging and cerebral angiography. Due to suboptimal control of pain with medical treatment, cervical sympathetic block was performed under fluoroscopic guidance using 20 ml of bupivacaine injected lateral to the posterior aspect of sixth vertebral body in both patients. On self-reported pain scale, the 58-year-old man reported improvement in pain intensity from 8/10 pain to 0/10 within 1 h of blockade. The patient remained relatively pain free for the 24-h post blockade. Mild recurrence of pain was noted on Day 2. The 43-year-old woman reported improvement in pain intensity from 6/10 pain to 0/10 within 1 h of blockade. The patient remained pain free for five days with recurrence to previous intensity. CONCLUSION: Cervical sympathetic blockade in patients with ICA dissection may be an effective option in the event of suboptimal pain control with medical treatment; however, the technique may be limited due to relatively short duration of action.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1703
[Cu] Class update date: 170816
[Lr] Last revision date:170816
[St] Status:PubMed-not-MEDLINE

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[PMID]: 27196022
[Au] Autor:McClelland S; Marascalchi BJ; Passias PG; Protopsaltis TS; Frempong-Boadu AK; Errico TJ
[Ad] Address:*Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY †Department of Anesthesiology, Johns Hopkins Hospital, Baltimore, MD ‡Department of Neurosurgery, NYU Langone Medical Center, New York, NY.
[Ti] Title:Impact of Race and Insurance Status on Surgical Approach for Cervical Spondylotic Myelopathy in the United States: A Population-Based Analysis.
[So] Source:Spine (Phila Pa 1976);42(3):186-194, 2017 Feb.
[Is] ISSN:1528-1159
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim of the study was to assess factors potentially impacting the operative approach chosen for cervical spondylotic myelopathy (CSM) patients on a nationwide level. SUMMARY OF BACKGROUND DATA: CSM is one of the most common spinal disorders treated by spine surgeons, with operative management consisting of three approaches: anterior-only, posterior-only, or combined anterior-posterior. It is unknown whether the operative approach used differs based on patient demographics and/or insurance status. METHODS: The nationwide inpatient sample from 2001 to 2010 was used for analysis. Admissions having a diagnosis code of 721.1 and a primary procedure code of 81.02/81.03, 81.32/81.33, 81.02/81.03, or 81.32/81.33 (combined anterior and posterior fusion/refusion at C2 or below), and 3.09 (decompression of the spinal canal including laminoplasty) were included. Analysis was adjusted for several variables including patient age, race, sex, primary payer for care, and admission source/type. RESULTS: Multivariate analyses revealed that non-white race (black [odds ratio, OR = 1.39; 95% confidence interval, CI = 1.32-1.47; P < 0.0001], Hispanic [OR = 1.51; 95% CI = 1.38-1.66; P < 0.0001], Asian/Pacific Islander [OR = 1.40; 95% CI = 1.15-1.70; P = 0.0007], Native American [OR = 1.33; 95% CI = 1.02-1.73; P = 0.037]) and increasing age (OR = 1.03; P < 0.0001) were predictive of receiving posterior-only approaches. Female sex (OR = 1.39; 95% CI = 1.34-1.43; P < 0.0001), private insurance (OR = 1.19; 95% CI = 1.14-1.25; P < 0.0001), and nontrauma center admission type (OR = 1.29-1.39; 95% CI = 1.16-1.56; P < 0.0001) were independently predictive of increased likelihood of receiving an anterior-only approach. Hispanic race (OR = 1.35; 95% CI = 1.14-1.59; P = 0.0004) and admission source (another hospital [OR = 1.65; 95% CI = 1.20-2.27; P = 0.0023], other health facility [OR = 1.68; 95% CI = 1.13-2.51; P = 0.011]) were the only variables predictive of increased combined anterior-posterior approaches; Native American race (OR = 0.32; 95% CI = 0.13-0.78; P = 0.013) decreased the likelihood of a combined anterior-posterior approach. CONCLUSION: Private insurance status, female sex, and white race independently predict receipt of anterior-only CSM approaches, whereasd non-white race (black, hispanic, Asian/Pacific Islander, Native American) and nonprivate insurance predict receiving posterior-only CSM approaches. Given recent literature demonstrating posterior-only approaches as predictive of increased mortality in CSM (Kaye et al, 2015), our findings indicate that for CSM patients, non-white race may significantly increase mortality risk, whereas private insurance status may significantly decrease the risk of mortality. Further prospective study will be needed to more definitively address these issues. LEVEL OF EVIDENCE: 3.
[Mh] MeSH terms primary: Cervical Vertebrae/surgery
Insurance Coverage/statistics & numerical data
Spondylosis/surgery
[Mh] MeSH terms secundary: African Americans
Continental Population Groups
Decompression, Surgical/methods
Female
Hispanic Americans
Humans
Laminectomy/methods
Laminoplasty/methods
Male
Prospective Studies
Reflex Sympathetic Dystrophy/mortality
Reflex Sympathetic Dystrophy/surgery
Spinal Fusion/methods
Spinal Osteophytosis/surgery
Treatment Outcome
United States
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 170912
[Lr] Last revision date:170912
[Js] Journal subset:IM
[Da] Date of entry for processing:160520
[St] Status:MEDLINE
[do] DOI:10.1097/BRS.0000000000001693

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[PMID]: 28025369
[Au] Autor:Bullen M; Lang C; Tran P
[Ad] Address:*Western Health Department of Orthopaedics, Melbourne, Victoria michael.bullen@wh.org.au.
[Ti] Title:Incidence of Complex Regional Pain Syndrome I Following Foot and Ankle Fractures Using the Budapest Criteria.
[So] Source:Pain Med;17(12):2353-2359, 2016 Dec.
[Is] ISSN:1526-4637
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVE : Fractures are a well-recognized inciting event in the development of complex regional pain syndrome. This study aimed to prospectively determine the incidence of complex regional pain syndrome following foot and ankle fractures. METHODS : A prospective study was conducted of patients presenting to two metropolitan hospitals with plain radiograph diagnosis of fractures to the foot or ankle. Patients were initially screened by phone 3 months after injury using the validated International Association for the Study of Pain Budapest criteria. Patients who fulfilled the screening criteria were then physically examined by a pain specialist to assess clinical signs as part of the Budapest criteria. RESULTS : A total of 306 consecutive eligible patients were included. One hundred and ten patients reported at least one symptom of complex regional pain syndrome; however, only three fulfilled the minimum requirements to necessitate clinical review. Of these three, only one patient fulfilled the combination of symptom and sign criteria for a positive diagnosis according to the validated Budapest criteria. The incidence of complex regional pain syndrome following foot and ankle fracture in this study was 0.3%. CONCLUSION : Although many patients may experience vasomotor, sensory, and sudomotor disturbance following a fracture to the foot and ankle, the observed incidence of complex regional pain syndrome using a prospectively collected validated criteria is significantly lower than previously published.
[Mh] MeSH terms primary: Ankle Fractures/complications
Foot Injuries/complications
Reflex Sympathetic Dystrophy/epidemiology
[Mh] MeSH terms secundary: Adolescent
Adult
Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Incidence
Male
Middle Aged
Prospective Studies
Reflex Sympathetic Dystrophy/etiology
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1710
[Cu] Class update date: 171003
[Lr] Last revision date:171003
[Js] Journal subset:IM
[Da] Date of entry for processing:161228
[St] Status:MEDLINE
[do] DOI:10.1093/pm/pnw055

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[PMID]: 27717112
[Au] Autor:Xu J; Tang Y; Xie M; Bie B; Wu J; Yang H; Foss JF; Yang B; Rosenquist RW; Naguib M
[Ad] Address:Department of Pain Management, Cleveland Clinic, Cleveland, OH, USA.
[Ti] Title:Activation of cannabinoid receptor 2 attenuates mechanical allodynia and neuroinflammatory responses in a chronic post-ischemic pain model of complex regional pain syndrome type I in rats.
[So] Source:Eur J Neurosci;44(12):3046-3055, 2016 Dec.
[Is] ISSN:1460-9568
[Cp] Country of publication:France
[La] Language:eng
[Ab] Abstract:Complex regional pain syndrome type 1 (CRPS-I) remains one of the most clinically challenging neuropathic pain syndromes and its mechanism has not been fully characterized. Cannabinoid receptor 2 (CB2) has emerged as a promising target for treating different neuropathic pain syndromes. In neuropathic pain models, activated microglia expressing CB2 receptors are seen in the spinal cord. Chemokine fractalkine receptor (CX3CR1) plays a substantial role in microglial activation and neuroinflammation. We hypothesized that a CB2 agonist could modulate neuroinflammation and neuropathic pain in an ischemia model of CRPS by regulating CB2 and CX3CR1 signaling. We used chronic post-ischemia pain (CPIP) as a model of CRPS-I. Rats in the CPIP group exhibited significant hyperemia and edema of the ischemic hindpaw and spontaneous pain behaviors (hindpaw shaking and licking). Intraperitoneal administration of MDA7 (a selective CB2 agonist) attenuated mechanical allodynia induced by CPIP. MDA7 treatment was found to interfere with early events in the CRPS-I neuroinflammatory response by suppressing peripheral edema, spinal microglial activation and expression of CX3CR1 and CB2 receptors on the microglia in the spinal cord. MDA7 also mitigated the loss of intraepidermal nerve fibers induced by CPIP. Neuroprotective effects of MDA7 were blocked by a CB2 antagonist, AM630. Our findings suggest that MDA7, a novel CB2 agonist, may offer an innovative therapeutic approach for treating neuropathic symptoms and neuroinflammatory responses induced by CRPS-I in the setting of ischemia and reperfusion injury.
[Mh] MeSH terms primary: Encephalitis/physiopathology
Hyperalgesia/physiopathology
Microglia/physiology
Receptor, Cannabinoid, CB2/physiology
Receptors, Chemokine/physiology
Reflex Sympathetic Dystrophy/physiopathology
[Mh] MeSH terms secundary: Animals
Benzofurans/administration & dosage
CX3C Chemokine Receptor 1
Disease Models, Animal
Encephalitis/complications
Encephalitis/prevention & control
Epidermis/innervation
Hyperalgesia/complications
Hyperalgesia/prevention & control
Ischemia/physiopathology
Male
Microglia/drug effects
Pain/prevention & control
Piperidines/administration & dosage
Rats
Rats, Sprague-Dawley
Receptor, Cannabinoid, CB2/agonists
Reflex Sympathetic Dystrophy/complications
Spinal Cord Dorsal Horn/drug effects
Spinal Cord Dorsal Horn/physiology
[Pt] Publication type:JOURNAL ARTICLE
[Nm] Name of substance:0 (1-((3-benzyl-3-methyl-2,3-dihydro-1-benzofuran-6-yl)carbonyl)piperidine); 0 (Benzofurans); 0 (CX3C Chemokine Receptor 1); 0 (CX3CR1 protein, rat); 0 (Cnr2 protein, rat); 0 (Piperidines); 0 (Receptor, Cannabinoid, CB2); 0 (Receptors, Chemokine)
[Em] Entry month:1711
[Cu] Class update date: 171116
[Lr] Last revision date:171116
[Js] Journal subset:IM
[Da] Date of entry for processing:161008
[St] Status:MEDLINE
[do] DOI:10.1111/ejn.13414

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[PMID]: 27376229
[Au] Autor:Najeeb T; Khan M
[Ad] Address:Department of ENT, Islamabad Medical and Dental College, Islamabad.
[Ti] Title:Sympathetic Chain Schwannoma Resembling Carotid Body Tumour.
[So] Source:J Coll Physicians Surg Pak;26(6 Suppl):S68-70, 2016 06.
[Is] ISSN:1681-7168
[Cp] Country of publication:Pakistan
[La] Language:eng
[Ab] Abstract:Schwannomas are rare, benign nerve sheath tumours of parapharyngeal space. Differential diagnosis should include salivary gland tumours, paragangliomas, neurofibromas, and metastatic lymph nodes. The tumours may arise from vagus nerve and cervical sympathetic chain (CSC). Diagnosis is usually made by imaging techniques: contrast CT, magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA). Fine needle aspiration cytology (FNAC) is useful diagnostic procedure but poor results are seen in neurogenic tumours. Rarely, a vascular CSC schwannoma at the level of carotid arteries bifurcation may mimic carotid body tumour (CBT) on imaging techniques, especially if they are vascular, causing splaying of internal and external carotid arteries. Clinically patient was asymptomatic except for a pulsatile swelling in neck for 5 years. The presented case resembled CBTclinically, on ultrasound and on imaging techniques causing splaying of carotid arteries. FNAC was inconclusive and was always hemorrhagic. During operation, it was found to be CSC schwannoma just posterior to carotid body. CSC was sacrificed and patient developed Horner syndrome postoperatively.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1607
[Cu] Class update date: 170504
[Lr] Last revision date:170504
[Js] Journal subset:IM
[St] Status:In-Process

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[PMID]: 27148776
[Au] Autor:Barrea C; Vigouroux T; Karam J; Milet A; Vaessen S; Misson JP
[Ad] Address:Division of Child Neurology, Department of Pediatrics, Centre Hospitalier Régional, Liège, Belgium.
[Ti] Title:Horner Syndrome in Children: A Clinical Condition with Serious Underlying Disease.
[So] Source:Neuropediatrics;47(4):268-72, 2016 Aug.
[Is] ISSN:1439-1899
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:Aim Horner syndrome corresponds to the clinical triad of miosis, ptosis, and facial anhidrosis. These symptoms are related to injury of the oculosympathetic chain. In children, Horner syndrome is classified as congenital or acquired. While the diagnosis is made through clinical examination, there is some debate regarding the use of imaging modalities and the extent of anatomical coverage required. Methods Here, we describe two cases of children with acute Horner syndrome. We then review the literature about the different etiology and discuss the interest of some investigations. Results Case 1: An 8-month-old girl without personal or familial history, has presented a right acquired Horner syndrome without additional signs. Frontal chest radiography and ultrasonography of the neck and the abdomen was first achieved and returned normal. The cerebral and cervical magnetic resonance imaging (MRI) with angiographic sequences performed in a second time was also normal. Finally, an enhanced thoracic computed tomography (CT)-scan demonstrated a mass at the right pulmonary apex. Case 2: A 9-year-old boy without personal or familial history has presented an acute headache with loss of consciousness during a basketball competition. Upon waking up, the child has right hemiplegia, aphasia, and left Horner syndrome. The cerebral CT scan realized in the first line was normal. The MRI with angiographic sequences demonstrated M1 left carotid dissection with homolateral white matter infarction. Conclusion Imaging studies seem critical in delineating the nature and extent of any underlying pathology along the oculosympathetic pathway in children presenting a Horner syndrome. In these patients, a history of trauma or surgery may reduce the need for extensive systemic evaluation. Without such anamnesis, a decision to proceed with further evaluation is made with consideration of the relative incidence of tumor, especially neuroblastoma, or other treatable lesions. In this condition, MRI is the more sensitive and recommended investigation.
[Mh] MeSH terms primary: Carotid Artery, Internal, Dissection/complications
Horner Syndrome/etiology
Lung Neoplasms/complications
Neuroblastoma/complications
[Mh] MeSH terms secundary: Basal Ganglia Cerebrovascular Disease/diagnostic imaging
Basal Ganglia Cerebrovascular Disease/etiology
Brain Infarction/diagnostic imaging
Brain Infarction/etiology
Carotid Artery, Internal, Dissection/diagnostic imaging
Child
Female
Humans
Infant
Lung Neoplasms/diagnostic imaging
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Male
Neuroblastoma/diagnostic imaging
Tomography, X-Ray Computed
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Entry month:1702
[Cu] Class update date: 170817
[Lr] Last revision date:170817
[Js] Journal subset:IM
[Da] Date of entry for processing:160506
[St] Status:MEDLINE
[do] DOI:10.1055/s-0036-1584085

  10 / 175 MEDLINE  
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[PMID]: 26899514
[Au] Autor:Padaki AS; Fitch RW; Stack LB; Thurman RJ
[Ad] Address:Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
[Ti] Title:Horner's Syndrome after Scalene Block and Carotid Dissection.
[So] Source:J Emerg Med;50(5):e215-8, 2016 May.
[Is] ISSN:0736-4679
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Horner's syndrome refers to the clinical triad of ptosis, miosis, and anhidrosis resulting from disruption of the ocular and facial sympathetic pathways. A myriad of etiologies can lead to Horner's syndrome; awareness of the underlying anatomy can assist physicians in identifying potential causes and initiating appropriate care. CASE REPORT: Two patients presented to our Nashville-area hospital in 2014. Patient 1 was a 26-year-old man who noticed facial asymmetry one day after an outpatient orthopedic procedure. His symptoms were attributed to his posterior interscalene anesthesia device; with deactivation of this device, the symptoms rapidly resolved. Patient 2 was a 42-year-old man who presented to our emergency department with persistent headache and ptosis over several weeks. Computed tomography angiography revealed ipsilateral carotid dissection and the patient was admitted for further management. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The pathologies underlying Horner's syndrome are exceedingly diverse. Although classic teaching often focuses on neoplastic causes, and more specifically Pancoast tumors, neoplasms are discovered only in a small minority of Horner's syndrome cases. Other etiologies include trauma, cervical artery dissection, and infarction. With a better understanding of the pertinent anatomy and array of possible etiologies, emergency physicians may have more success in identifying and treating the causes of Horner's syndrome.
[Mh] MeSH terms primary: Aneurysm, Dissecting/complications
Brachial Plexus Block/adverse effects
Carotid Artery Diseases/complications
Horner Syndrome/etiology
Horner Syndrome/physiopathology
[Mh] MeSH terms secundary: Adult
Emergency Service, Hospital/organization & administration
Headache/etiology
Humans
Magnetic Resonance Angiography/methods
Male
Tomography, X-Ray Computed/methods
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 170918
[Lr] Last revision date:170918
[Js] Journal subset:IM
[Da] Date of entry for processing:160223
[St] Status:MEDLINE


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