Clinical Reasoning: Partial Horner syndrome and upper right limb symptoms following chiropractic manipulation

Risk factors for the development of Horner’s syndrome following interscalene brachial plexus block using ropivacaine for shoulder arthroscopy: a randomised trial

“…It is characterized by miosis, ptosis, and anhidrosis, with or without enophthalmia. It may occur after a number of pathologies associated with the cervical region [1][2][3][4][5][6][7] or epidural [8], spinal anesthesia [9], as well as combined spinal-epidural anesthesia [10]. Despite the different techniques for blocking brachial plexus performed by the interscalene [11], transscalene [12], and sometimes, supraclavicular [13,14], and infraclavicular [15] local anaesthetics (LA), could still diffuse via the prevertebral spaces, block sympathetic nerves in the cervical region, as well as also spread to the sympathetic ganglia (the stellate ganglion), and could cause transient characteristic symptoms [16].…”

Horner’s syndrome secondary to T1-T2 intervertebral disc prolapse

“…[24,26] e uncommonness of this condition is probably due to the relative stability of the vertebral column at this level. [17] Horner's syndrome in association with T1-T2 IVDP [5,6,11,[13][14][15]20,23,25,27,28] has only been rarely reported. e oculosympathetic pathway consists of central, preganglionic, and postganglionic neurons with two relay centers, the ciliospinal center of Budge and the superior cervical ganglion.…”

“…Among these reported cases of T1-T2 IVDP, we were able to identify Horner's syndrome in only 11 cases (26.2%). [5,6,11,[13][14][15]20,23,25,27,28] [Table 1] summarizes all the 11 cases of T1-T2 IVDP associated with Horner's syndrome published in the literature. e age of these patients ranged from 29 to 60 years.…”

“…ere was a male preponderance. Scapular pain, [15,20,23,27,28] thoracic back pain, [11] upper limb radiculopathy, [5,6,11,[13][14][15]20,23,25,27,28] sensory loss, [5,6,11,15,23,27,28] and weakness of intrinsic muscles of the hand [6,11,13,15,20,23,27] were the presenting symptoms.…”

Erythema migrans associated with partial Horner's syndrome

“…Lyme disease associated with Horner's syndrome due to sympathetic nerve involvement has been described in the literature 6. Partial Horner's syndrome is usually caused by a lesion of the preganglionic nerve fibres at the level of the internal carotid artery, or postganglionic nerve involvement at the level of first thoracic (T1) vertebrae 7. Possible causes can include a stroke or local tumour, but in 40% of cases, the causes are unidentified 8.…”