Horner's Syndrome and NHL

[M-K-Kroeger]

    
      Re: Horner's Syndrome and NHL
    


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Posted by ccf neuro M.D. on May 26, 1997 at 12:13:54:

In Reply to: Horner's Syndrome and NHL posted by M. K. Kroeger on May 18, 1997 at 12:29:38:

: Patient has diffuse, large-cell NHL with Horner's Syndrome. If lymphoma has reached the cranial nerves, is there any treatment (including clinical trials) outside of pallative medicine? Thanks.
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An intersting question. Horner's syndrome is the result of interruption of fibers known as sympathetic nervous ystem fibers taht travel all the way from the base of the brain to the eye. If damaged, they result in constriction of the pupil, drooping of the eyelid, and loss of sweating on the affected side of the face plus or minus body. A Horner's syndrome is not the result of a cranial nerve lesion per se, but rather implies that these specific fibers are damaged somewhere between the brain and the thoraccic spinal cord, from which they originate. Damage to a structure called the sympathetic chain ganglia often occurs in ceratin cancers and results in this problem, but the problem in this case is in the mid chest or so-called mediastinum area. If there is true cranial nerve invlovement, it suggests a condition called lymphomatous meningitis, in which the lymphoma cells have reached the covering memebranes of the brain called the meninges, and have then multiplied and literally strangulated each involved      cranial nerve as it makes its way out of the brain through the meninges on its way to its final destination. Treatment of this problem requires special chemotrherapy agents that are instilled into the spinal fluid. As to appropriate therapies or clinical trials for non-Hodgkins lymphomas, this falls outside the realm of expertise of neurologists, and is in the domain of oncologists (medical oncologists). I should also mention that sometimes a Hormer's syndrome can result from RADIATION induced damage to the mediastinum, resulting from either scarring of the cervical sympathetic chain ganglia, and/or radiation induced blood vessel inflammation and damge, that can ultimately cause strokes if it gets sevre enough. At any rate, I would strongly advise evaluation by a neurologist ASAP to clarify what part of the nervous system the Horner's syndrome might be coming from, as well as to search for any other evidence of damage to the nervous system, including the cranial nerves as you are specifically concerned      about. Appropriate localization of the lesion will help guide treatment decisions and wheteher or not additional diagnostic studies such as brain or chest imaging or lumbar puncture (spinal tap) are required. If you are intersetd in having this patient evaluated at the Cleveland Clinic, our neurology appointment number is 1-800-223-2273 ext. 4559 or 216-444-5559. The 1-800 number could also connect you to medical oncology if you are intersetd in s econd opinion there. I hope you find this information useful.