Horner's Syndrome and MS?

    
      Re: Horner's Syndrome and MS?
    


[ Follow Ups ] [ Post Followup ] [ Neurology and Neurosurgery Forum ] [ FAQ ]



Posted by CCF Neuro MD on February 10, 1998 at 09:55:11:

In Reply to: Horner's Syndrome and MS? posted by Barbara on February 10, 1998 at 08:42:33:

: I have a diagnosis of probable MS over the last 6 years (following a positive MRI and continuing mild clinical signs).  A problem for which I have found no explanation is a "shadow" affecting my left eye.  At least two times, several years apart, the left eyelid drooped about 1/2 way down for a few weeks and then went back to normal, but this "shadow" has been a fairly constant companion over the last 6 years beginning just before the neuro problems that led to my original workup for MS.  I may not notice it for a while, but if I am overheated, using my eyes in a stressful way - such as looking at a pc monitor for long periods - it is very prominent and a real nuisance.  Two opthalmologists over those years have performed only cursory exams and declared that even though they saw no sign of ON, it must be related to a ON attack at some time.  The exams were both so short (eyes not dilated, etc. - one exam lasted only about 1 minute), that I believe the probable MS dx was the sole source of the diagnosis.  I should say there has been no loss of vision in that eye - no blurring or field deficit - only this sensation of less light in that eye and possibly a slight feeling that the left eye has trouble "catching up" with the right.
  I have recently read about "Horner syndrome" which I understand causes the pupil to remain restricted and might also cause the eyelid to droop.  Could all this be related to MS?  (My understanding is that Horner's is due to a problem in the sympathetic nervous system - as distinct from central?)  Is Horner syndrome a realistic possibility?  And if so, is there anything that can be done for it?
  Thank you for your response.   Even though this is not disabling, it is very distracting and I would like to know if anything might be done to help it.
==========================================================================
Horners syndrome is an unusual manifestation of MS,however it has been
described, there have been about eight case reports which link the two
entities inthe literature over the past thirty years.
Horners is as you say due to a lesion of the sympathetic nervous system,
but this has a central as well as a peripheral component so an MS
plaque in the brain stem, in particular in the medulla where it joins the spine
could cause a horner's syndrome.
The fact that this worsens when you are overheated is very suggestive of MS
,as a basis as this is called Uthoff's phenomenon and is a feature of
all MS synptoms. If this is due to MS the mechanism would be independent
of optic neuritis as it would be due to a plaque in an entirely different
part of the nervous system.
There is no specific treatment for horner's apart from treatment of the
underlying disorder.
It is important ot note that a transient Horner's can also be seen in association with
Migraine and cluster headache.