Horner syndrome

Japanese: ホルネル症候群 - ホルネルしょうこうぐん（英語表記）Horner syndrome
Horner syndrome

What is the disease?

Anisocoria due to abnormalities in the oculosympathetic nerve Ptosis ( Fighting hard ) This is a condition that causes sweating disorders.

What is the cause?

Syringomyelia ( Spinal cord injury diagnosis ) , chest tumor ( Main ) Surgical stress, internal carotid artery dissection, Cavernous sinus ( Kaimenjo Myakuto ) It may be caused by disease etc.

How symptoms manifest

Due to paralysis of the pupillary dilator muscle, the affected eye has difficulty dilating, so anisocoria becomes more noticeable in the dark (the affected eye has miosis). Tarsal muscle ( Healthy ) The Muller muscle is also innervated by the ocular sympathetic nerve, so it can cause mild ptosis and Palpebral fissure ( Research ) It is accompanied by narrowing (Fig. 59).

In addition, because the sympathetic nervous system stimulates sweating, depending on the area affected, it can cause sweating disorders in the face, neck, and other parts of the body.

Testing and diagnosis

The pupil diameter of both eyes is observed in a bright and dark place, and it is confirmed that the anisocoria is more pronounced in the dark. In addition, eye drop tests using cocaine, tyramine, low-concentration epinephrine, etc. are performed to check the pupil's reaction to each eye drop, and the diagnosis and location of the disorder are determined. After that, imaging tests such as MRI are performed as necessary to identify the underlying disease.

Treatment methods

It is important to find the underlying cause and treat it. In particular, in children, it is often caused by a serious illness such as a tumor, so caution is required. neck ( Keibu ) After trauma pain ( To ) If this condition is accompanied by other symptoms, it may be due to internal carotid artery dissection and requires emergency treatment.

Figure 59 Horner's syndrome (left eye)
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Figure 59 Horner's syndrome (left eye)


Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　眼交感神経の異常により瞳孔不同・眼瞼下垂(がんけんかすい)・発汗障害などが起きる状態です。

原因は何か

　脊髄空洞症(せきずいくうどうしょう)、胸部の腫瘍(しゅよう)や手術侵襲、内頸動脈解離や海綿静脈洞(かいめんじょうみゃくとう)病変などが原因になることがあります。

症状の現れ方

　瞳孔散大筋の麻痺により、患眼は散瞳しにくくなるため、暗所で瞳孔不同が顕著になります（患眼が縮瞳）。上下の眼瞼を開くはたらきの瞼板筋(けんばんきん)（ミュラー筋）も同じく眼交感神経の支配を受けているため、軽度の眼瞼下垂と瞼裂(けんれつ)狭小を伴います（図59）。

　また交感神経は発汗を促すため、障害部位により顔面、首、半身の発汗障害を起こすことがあります。

検査と診断

　両眼の瞳孔径を明所と暗所で観察し、暗所で瞳孔不同が著明になることを確認します。その他、コカイン・チラミン・低濃度エピネフリンなどの点眼試験を行い、各点眼薬に対する瞳孔の反応を調べることで、診断と障害部位の判定を行います。そのうえで、必要に応じてMRI等の画像検査を行い、原疾患を調べます。

治療の方法

　原疾患を検索し、原疾患の治療を行うことが大切です。とくに小児の場合は腫瘍など重篤な疾患を背景に発症することが多いため注意が必要です。また頸部(けいぶ)外傷後に疼痛(とうつう)を伴って発症する場合は内頸動脈解離が原因の可能性があり、緊急な対応が必要です。

図59　ホルネル症候群（左眼）
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図59　ホルネル症候群（左眼）


出典　法研「六訂版 家庭医学大全科」六訂版 家庭医学大全科について　情報

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