Mazof Charles J, Bui Derek H, Aner Musa M
Geisel School of Medicine at Dartmouth. 1 Rope Ferry Road, Hanover, NH, 03755, USA.
Center for Pain and Spine, Dartmouth-Hitchcock Medical Center. 1 Medical Center Drive, NH, 03756, USA.
Interv Pain Med. 2025 Jul 29;4(3):100615. doi: 10.1016/j.inpm.2025.100615. eCollection 2025 Sep.
Horner's syndrome is a clinically significant condition caused by disruption of the oculosympathetic nerve pathway, typically presenting with ptosis, miosis, and facial anhidrosis. It can result from serious, life-threatening conditions such as trauma, carotid artery dissection, or malignancy; however, it may also arise from iatrogenic reasons, including stellate ganglion blocks, by other surgical interventions of the head and neck. While exceedingly rare, Horner's syndrome has been reported to occur after a cervical epidural steroid injection. Given the various potential etiologies of Horner's syndrome, prompt evaluation is required to rule out life-threatening conditions in the setting of an acute and unexpected presentation. This case study describes a presentation of Horner's syndrome following a cervical epidural steroid injection (ESI) for a cervical radiculopathy. Due to the unusual nature, a serious cerebrovascular event was initially considered and urgent evaluation was advised. Fortunately, all symptoms resolved fully within two hours without medical intervention. It has been suggested that local anesthetic diffusion to the preganglionic neurons caused pharmacologic disruption of the sympathetic fibers. This case provides additional evidence to the limited reports of Horner's syndrome after cervical epidurals. It also highlights the importance of minimizing or forgoing local anesthetics, considering non-particulate steroids, and conducting emergent evaluation for new onset of neurological deficits during or after cervical ESIs.
霍纳综合征是一种具有临床意义的病症，由眼交感神经通路中断引起，典型表现为上睑下垂、瞳孔缩小和面部无汗。它可能由严重的、危及生命的情况导致，如创伤、颈动脉夹层或恶性肿瘤；然而，它也可能由医源性原因引起，包括星状神经节阻滞以及头颈部的其他外科手术干预。虽然极为罕见，但据报道，霍纳综合征可在颈椎硬膜外类固醇注射后发生。鉴于霍纳综合征有多种潜在病因，在急性且意外出现该病症时，需要迅速进行评估以排除危及生命的情况。本病例研究描述了一例因颈椎神经根病接受颈椎硬膜外类固醇注射（ESI）后出现霍纳综合征的情况。由于情况不寻常，最初考虑为严重的脑血管事件，并建议进行紧急评估。幸运的是，所有症状在两小时内未经医学干预即完全缓解。有人认为，局部麻醉药扩散至节前神经元导致了交感神经纤维的药理学破坏。本病例为颈椎硬膜外注射后发生霍纳综合征的有限报告提供了更多证据。它还强调了在颈椎ESI期间或之后尽量减少或避免使用局部麻醉药、考虑使用非颗粒状类固醇以及对新出现的神经功能缺损进行紧急评估的重要性。
