Horner's syndrome after blunt cervical and chest trauma: case report

Abstract

-Horner's syndrome is the triad of miosis, ptosis, and anhidrosis, resulting from disruption of the sympathetic pathways. This article describes an uncommon case of Horner's syndrome in a 22-year-old man after blunt trauma to the neck and chest without carotid artery dissection. The patient was brought to the emergency service after motorcycle fall. Neurologic examination revealed a patient presenting the score 15 at Glasgow Coma Scale. The left eyelid was 1-2 mm lower than the right. Carotid Doppler and angiotomography were undertaken and revealed no abnormalities of the carotid artery. CT disclosed a mediastinal hematoma extending to the left apex, compressing the left sympathetic chain. The understanding of this clinical entity may help the surgeon to make a better differential diagnosis in trauma patients in whom prompt diagnosis is critical to stablish the correct treatment.KEY WORDS: Horner syndrome, trauma, etiology. Síndrome de Horner após trauma cérvico-torácico fechado: relato de casoRESUMO -A síndrome de Horner compreende a tríade de miose, ptose e anidrose, resultado de lesão em algum ponto das vias simpáticas. O referido estudo apresenta um caso da referida síndrome em um jovem de 22 anos vitima de queda de moto, com escoriações no tórax e no pescoço, sem dissecção carotídea. Ao exame neurológico, encontrava-se com 15 pontos na Escala de Coma de Glasgow, com miose à esquerda e ptose palpebral ipsilateral. Realizado Doppler de carótidas e angiotomografia dos vasos cérvico-cranianos não sendo evidenciadas anormalidades. A tomografia de tórax mostrou um hematoma no ápice pulmonar esquerdo, comprimindo a cadeia simpática ipsilateral. O conhecimento desta entidade clínica pode ajudar o cirurgião a fazer um diagnóstico diferencial adequado nos pacientes vítimas de traumas, nos quais o diagnóstico correto e eficaz pode ser fundamental para a definição da conduta a ser tomada. Campos, Horner's syndrome consists of a triad of symptoms (miosis, ptosis, and anhydrosis) resulting from disruption of the sympathetic pathways somewhere between the brain and the eyes. In blunt trauma, it is usually associated with carotid artery dissection. Although the individual signs of Horner's syndrome do not constitute an emergency, the internal carotid artery proximity to the sympathetic ganglia makes Horner's syndrome a potential vascular emergency [1][2][3] . PALAVRAS-CHAVE Dr. Wellingson Paiva -Rua Ovidio Pires deWe present a case of Horner's syndrome in a 22-year-old man after blunt trauma to the neck and head unrelated to carotid artery dissection. CASEA 22-year-old man was brought to the emergency room after motorcycle fall, with history of transitory loss of conscience. In the admition, he was alert and orientated, the carotid pulses were symmetric, regular in rate and rhythm, with no bruits and the chest and the abdomen had no signs of abnormalities. The patient related moderate cervical pain but no neurological defi cits were noticed except for the asymetric pupils that measured 5 mm on the right and 2 mm ...