Re: Horner's Syndrome

Posted By CCF Neurology MD on September 18, 1997 at 19:32:52:

In Reply to: Horner's Syndrome posted by Shelly Starbuck, OTR on September 10, 1997 at 17:29:57:







: Hello:
I am an Occupational Therapist in the school system and have recently received a referral for a little boy (7 y.o.) with the diagnosis of Horner's Syndrome.  I've read about this syndrome but have some questions.
After evaluating him, the only area of weakness or limitation I discovered was in visual and auditory processing.  He had difficulty comprehending directions and needed demonstration most of the time.  He also had difficulty naming letters or remembering how to form the letters of the alphabet.  It seemed like an aphasia-type problem.  Are these symptoms or limitations ever found associated with Horner's Syndrome or is there some other learning disability going on?
Thank you in advance for your response.

Shelly Starbuck, OTR




Dear Shelly:
As you may know, Horner's syndrome refers to the following combination of signs, usually on one side of the face:
Miosis (smaller pupil), ptosis (droopy eyelid), enophthalmos (less prominent bulge of the eye), anhydrosis (loss of sweating - on the face), and loss of the ciliospinal reflex.
As is obvious, this combination of signs does not constitute the indication for a referral to an occupational therapist! Hence, it is likely that the underlying CAUSE of the Horner's syndrome is the reason for referral to you, and that it would be a good idea to ask the child's pediatrician/neurologist about this matter.
Horner's syndrome results from interruption of the sympathetic nervous supply to one side of the eye and face at any site (which includes the brain, the brainstem, the T1 nerve root, the peri-carotid region, and the base of the skull - the sympathetic nerve fibers have a long, counter-intuitive way of reaching their final destination).
Pathologies include tumors, trauma, stroke, vascular-such as carotid dissection, and various others.
I hope this answers your question.
Good luck!