Horner's syndrome: a rare presentation of cervical sympathetic chain schwannoma

Abstract

We describe a cervical sympathetic chain schwannoma in a 77-year-old woman who presented with a neck mass and Horner's syndrome. Such schwannomas are rare and this is the first documented case of a Horner's syndrome at presentation. The mass was excised via a cervical approach and her post-operative course was uneventful. The prognosis is excellent, with recurrence being rare. A brief discussion of the pathology, presentation, diagnosis, and treatment of this condition is made in this paper. The relevance of the uncertainty in diagnosis is discussed with the message that a pre-operative Homer's syndrome may guide the surgeon in the care of the patient but we suggest that in all cases proper counselling of the possible neurological consequences of this surgery be conducted.

Cervical Sympathetic Neuralgia Arising From a Schwannoma

“…Of particular interest was the evidence of asymmetrical sympathetic dysfunction. Whereas previous descriptions of cervical sympathetic chain schwannomas have emphasized the clinical hallmark of an ipsilateral oculosympathetic deficit, 3–8 our patient did not have a Horner syndrome. This is because the tumor at the level of T 2 would have spared the sympathetic fibers destined for the pupil and levator palpebrae muscle, which most commonly exit the spinal cord at the level of C 7 ‐T 1 and ascend through the cervical sympathetic chain.…”

“…Most are slow growing, benign, and for a long time remain asymptomatic and clinically undetectable. There have been rare reports of ocular sympathetic deficits, ie, Horner syndrome, associated with schwannoma involving the cervical sympathetic chain 3–8 . We report an unusual case of painful sympathetic chain schwannoma with unilateral sympathetic hyperactivity and correlate clinical, electrophysiologic, imaging, and pathologic findings.…”

Pediatric Isolated Sinonasal Schwannoma: A New Case Report and Literature Review

“…The age of our patient is unusual as most of these cases occur between the third and fifth decades of life according to reports [11–13], and the youngest patient that has been well documented is just 10 years old [14]. Also this, to the best of our knowledge, is the only case reported with a wide range of calcification in the lesion showed by CT scan [3, 10, 15].…”

Diagnosis and management of cervical sympathetic chain schwannoma: A review of 9 cases

“…The presence of Horner's syndrome before excision has only been recorded in 6 cases of CSCS [5,7]. The existence of Horner's syndrome before surgery is not diagnostic of tumor arising from sympathetic nerves, as effects could arise by compression from masses of other origins [8].…”