Alstadhaug Karl B
Nevrologisk avdeling, Nordlandssykehuset Bodø, Norway.
Tidsskr Nor Laegeforen. 2011 May 20;131(9-10):950-4. doi: 10.4045/tidsskr.10.0935.
Horner's syndrome is characterized by the classic triad of eyelid ptosis, miosis and facial anhidrosis and is caused by an interruption of the oculosympathetic nerve pathway somewhere between its origin in the hypothalamus and the eye.
This review is based on own experiences and a discretionary selection of articles found through non-systematic searches in PubMed. Cases from own practice serve as examples.
Based on localization of the nerve pathway interruption, a Horner's syndrome is often classified as central, pre- or postganglionic. For the central type the syndrome is associated with other symptoms and signs from the central nervous system. The preganglionic type is most often caused by a tumor or trauma. The postganglionic type is often associated with pain/headache; most frequently it is seen as a consequence of carotid artery dissection or during cluster headache. Anhidrosis is rarely prominent, and in the postganglionic subtype it is virtually absent. Pharmacological tests can be used in diagnostics. Apraclonidine seems to be a good alternative to cocaine to confirm Horner's syndrome. MRI is generally recommended in the evaluation, if necessary with special sequences.
The path of the long oculosympathetic fibers is complex and not fully understood. Topographic diagnostics may be challenging, but in most cases a specific cause is identified.
霍纳综合征的特征为典型的三联征，即眼睑下垂、瞳孔缩小和面部无汗，其病因是眼交感神经通路在从下丘脑起源至眼部的某个部位受到阻断。
本综述基于自身经验以及通过在PubMed中进行非系统检索筛选出的文章。以自身临床实践中的病例为例。
根据神经通路阻断的部位，霍纳综合征常被分为中枢性、节前性或节后性。中枢型综合征与中枢神经系统的其他症状和体征相关。节前型最常见的病因是肿瘤或创伤。节后型常伴有疼痛/头痛；最常见于颈动脉夹层或丛集性头痛发作时。无汗症状很少显著，在节后亚型中几乎不存在。药理学检查可用于诊断。阿可乐定似乎是替代可卡因确诊霍纳综合征的良好选择。一般建议在评估时进行MRI检查，必要时采用特殊序列。
眼交感长纤维的路径复杂且尚未完全明确。定位诊断可能具有挑战性，但在大多数情况下可确定具体病因。
