Wu Li, Luo Ming, Jiang Yongjun
Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, 250 Changgang East Road, Guangzhou, 510260, China.
Clin Auton Res. 2023 Feb;33(1):63-67. doi: 10.1007/s10286-022-00914-w. Epub 2022 Dec 12.
Horner syndrome presents with ipsilateral ptosis, miosis, and anhidrosis due to interruption of the oculosympathetic pathway. Patients with acute ischemic stroke may present with Horner syndrome, which may help locate the lesion. However, the underlying pathways involved in Horner syndrome caused by isolated lenticulostriate ischemic stroke remain unclear.
We screened consecutive patients with acute ischemic stroke admitted to the Second Affiliated Hospital of Guangzhou Medical University from 1 January 2020 to 31 December 2021, and searched for cases of isolated lenticulostriate strokes presenting with Horner syndrome. Strokes involving the brainstem or hypothalamus, or those caused by carotid dissection or carotid cavernous fistula were excluded based on neuroimaging and cerebrovascular examination.
Among the 1706 acute stroke patients, three patients developed temporary or long-term Horner syndrome due to an ipsilateral lenticulostriate ischemic lesion. Diffusion-tensor imaging revealed disruption of an uncrossed pathway from Brodmann areas 3, 1, and 2 through the basal ganglia to the ipsilateral hypothalamus.
These findings suggest that Horner syndrome may be due to a disruption of an uncrossed cortico-basal ganglia-hypothalamic sympathetic pathway.
霍纳综合征因眼交感神经通路中断而表现为同侧上睑下垂、瞳孔缩小和无汗。急性缺血性脑卒中患者可能出现霍纳综合征，这可能有助于定位病变。然而，由孤立性豆纹状动脉缺血性脑卒中引起的霍纳综合征所涉及的潜在通路仍不清楚。
我们筛选了2020年1月1日至2021年12月31日入住广州医科大学附属第二医院的连续急性缺血性脑卒中患者，并寻找出现霍纳综合征的孤立性豆纹状动脉卒中病例。根据神经影像学和脑血管检查，排除累及脑干或下丘脑的卒中，或由颈动脉夹层或颈动脉海绵窦瘘引起的卒中。
在1706例急性脑卒中患者中，3例因同侧豆纹状动脉缺血性病变出现了暂时性或长期性霍纳综合征。弥散张量成像显示，从布罗德曼区3、1和2通过基底神经节到同侧下丘脑的一条未交叉通路中断。
这些发现表明，霍纳综合征可能是由于未交叉的皮质-基底神经节-下丘脑交感神经通路中断所致。
