A 20 y.o. presents is unconscious after a gsw to the face; he was intubated in theED for ongoing bleeding
what do you notice about his forehead?
Our patient had a Horner’s syndrome after trauma to the neck. Horner’s syndrome results from damage to the cervical sympathetic chain. Nerves travel from the hypothalamus to the stellate and superiorcervical ganglia and then to the eye; innervating the levator palpebrae and dilator papillae. The syndrome consists of Ptosis, meiosis, and anhidrosis on the side of the lesion.
In addition to trauma, the sympathetic chain can be interrupted by tumor, aneursyms, high positions of chest tubes, carotid artery dissection and giant cell arteritis.
An ED patient with a sympathectomy
Cocaine or phenylephrine can be used to confirm a diagnosis of Horner’s. Cocaine acts by blocking reuptake of norepinephrine in the neuromuscular junction of the iris dilator muscle, causing the pupil in a normal eye to dilate, while no or incomplete dilatation occurs in Horner’s.
our pts ct showing facial fractures
In the case of our patient, the bullet caused fractures of all walls of the maxillary sinus, orbit, the L pterygoid process, both pterygoid plates, the L zygoma, nasal fracture, C1 fracture and hard palate fracture and causing a hematoma in the posterior neck . He had a L lateral cathotomy, and L internal carotid thrombosis proximal to C1. He underwent repairs of the mandible and orbit. Presumably, the Horner’s was the result of blast injury.
Wellingson D, Robson L, Wagner M, et al. Horner’s syndrome after blunt cervical and chest trauma case report. 2007;Arq. Neuro-Psiquiatr. Vol 65 no 4 .
Sayan M, Celik A. The development of Horner syndrome following a stabbing. 2014 . Case Reports in Medicine Vol 2014Article ID 461787
Bell R, Atweh M, Possenti P. Traumatic and iatrogenic Horner syndrome: case reports and review of the literature. Journal of Trauma 2001 Vol 51 (2);400-404
Walton K, Buono L, Horner syndrome, Current Opinion in Ophthalmology,2003. vol 14(6):357-363.