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Background Polyneuritis cranialis (PNC), a rare variant of Guillain-Barré syndrome (GBS), is usually characterized by ocular and pharyngeal weakness without obvious numbness or weakness of the limbs or ataxia. Horner’s syndrome is extremely rare in patients with PNC. Here, we describe a case of GBS presenting with acute PNC and unilateral Horner syndrome. Case presentation A 53-year-old male presented with headache, abducent paresis, peripheral-type facial palsy, bulbar type dysarthria, decreased gag reflex and tongue palsy. Neurological examination showed Cranial Nerve V, VI, VII, IX, X and XII were affected, and Horner’s syndrome was observed. Cerebrospinal fluid analysis showed albuminocytologic dissociation. Sensorimotor conduction velocity and needle electromyography of limbs were normal. Magnetic resonance imaging of brain was normal. Finally, the patient was diagnosed as PNC combined with Horner’s syndrome. The patient received plasma exchange and intravenous immunoglobulin, which relieved the symptoms rapidly. Conclusion GBS presenting only as Horner syndrome and PNC is a challenge for etiological diagnosis. Clinicians need to know enough to distinguish GBS and its variants from other potential similar diseases.

A 5‐year‐old male golden retriever was presented after a subacute onset of left‐sided Horner syndrome (HS). The dog had anisocoria with left‐sided miosis, ptosis of the upper eyelid, and third eyelid protrusion in the left eye. Because of the absence of additional neurological abnormalities, clinical signs were suggestive of left isolated HS, and the lesion was localized at the level of either the preganglionic or postganglionic neuron of the sympathetic chain. Magnetic resonance imaging (MRI) of the head and total body computed tomography (CT) identified marked narrowing and irregularity of the left internal carotid artery (ICA) in addition to loss of normal vessel flow‐void and T1‐weighted hyperintensity in the lumen of the left ICA. Except for these abnormalities, MRI and CT results were normal. These findings were suggestive of left internal carotid artery dissection (ICAD), suggesting that ICAD should be considered as a possible differential diagnosis of HS in dogs.

Discussion Horner’s syndrome can result from a lesion at any level along the sympathetic pathway and is classified as first-order neurone, second-order neurone and third-order neurone types.1 Lesion localisation depends on the associated neurological findings and the pupillary response to pharmacological agents,2 though these are not readily available in neurology clinics. Localisation can influence the choice of type of imaging modality and the area scanned.1 The third-order sympathetic fibres start from the superior cervical ganglion. Key points The Horner’s syndrome and the cranial nerve palsies that result from an internal carotid artery dissection vary with the location and size of the dissection, and may challenge traditional anatomical understanding.

Horner syndrome is a rare complication following thyroid surgery, typically presenting with ptosis, miosis, and ocular congestion. We report the case of a 30-year-old female diagnosed with papillary thyroid carcinoma who underwent left thyroid lobectomy, isthmectomy, and comprehensive left cervical lymph node dissection. On the first postoperative day, the patient developed left-sided ptosis, a constricted pupil, blurred vision, and conjunctival congestion, leading to a clinical diagnosis of Horner syndrome. Initial treatment with oral neurotrophic agents provided limited improvement, with persistent ocular symptoms. Four months postoperatively, the introduction of topical naphazoline eye drops resulted in marked improvement. Ptosis diminished, the palpebral fissure returned to normal, pupil sizes equalized, and conjunctival congestion resolved, with effects lasting approximately 2 h after each application. This case report summarizes the mechanisms of injury leading to Horner syndrome after thyroid surgery, highlighting the importance of understanding the anatomical relationship between the thyroid gland and the cervical sympathetic nerve trunk during thyroidectomy to minimize the risk of Horner syndrome. This case highlights the potential role of topical α1-adrenergic agonists in managing postoperative Horner syndrome and underscores the need for intraoperative nerve protection strategies.

ObjectiveHorner’s syndrome (HS) is characterised by a triad of ocular miosis, ptosis and anhidrosis. HS may be a subtle sign of occult pathology in otherwise asymptomatic children, neuroblastoma (NBL) being the the most common associated malignant tumour. Despite such knowledge, the incidence of underlying malignancy in children with HS remains unclear and robust evidence to guide best clinical practice is sparse. We performed a systematic review of the literature with the aim of identifying the incidence of NBL in children with HS of unknown aetiology, and establishing if screening for NBL should be routinely performed in this patient population.MethodsSystematic review of the literature (PubMed and Ovid/Medline database, 1961–2018).ResultsThe initial search identified 334 manuscripts, of which 8 studies were included in the final analysis. All reports were single-centre retrospective studies without control groups and included a total of 152 patients (age range 0–20 years). All studies investigated patients with HS but without previously established diagnosis. In the studies included, 17 out of a total of 152 patients were diagnosed with a space-occupying lesion. 12 out of the 152 patients were subsequently detected with NBL.ConclusionHS in children may be the first sign of occult malignancy. We report the first systematic review that comprehensively investigates the incidence of malignancy in this unique patient cohort. We show that HS of unknown aetiology in children warrants further investigation(s) to exclude an underlying space-occupying lesion. This should include cross-sectional imaging of the brain, neck and thorax, plus urinary catecholamines for prompt diagnosis and treatment.

A 56-year-old man presented to the clinic with episodic headaches for several years which had been worsening over a few months prior to the presentation. He described headache as sharp, stabbing pain around the left eye associated with nausea, vomiting, photophobia, and phonophobia lasting for hours associated with flushing on the left side of the face. The picture of his face during these episodes showed flushing of the left side of the face, ptosis of the right eyelid, and miosis (panel A). Flushing in his face would resolve with the abortion of the headache. At the time of presentation to the clinic, his neurological exam was only significant for mild left eye ptosis and miosis (panels B and C). Extensive workup including MRI brain, cervical spine, thoracic spine, lumbar spine, CTA head and neck, and CT maxillofacial was unremarkable. He had tried several medications in the past including valproic acid, nortriptyline, and verapamil without significant benefit. He was started on erenumab for migraine prophylaxis and was given sumatriptan for abortive therapy following which his headaches improved. The patient was diagnosed with idiopathic left Horner’s syndrome and his migraines with autonomic dysfunction would present with unilateral flushing opposite to the site of Horner’s presenting as Harlequin syndrome [1, 2].

Background Chondroma is a slowly growing, benign cartilaginous tumor which predominantly occurs in long bones of the hands and feet. Primary mediastinal chondroma is rare, especially with Horner’s syndrome. Case presentation We reported the case of a 31-year-old woman with a posterior mediastinum mass associated with Horner’s syndrome. After complete dissection of the mass, a pathological diagnosis of the primary mediastinal chondroma was rendered. The patient has shown no local recurrence or distal disease in a 3.5-year follow-up period. Conclusions The preoperative diagnosis of chondroma should combine various examinations for comprehensive evaluation. Complete surgical resection should be the first choice of the treatment due to the risk of malignancy.

Our research letter investigates the potential, as well as the current limitations, of widely available text-to-image tools in generating images for medical education. We focused on illustrations of important physical signs in the face (for which confidentiality issues in conventional patient photograph use may be a particular concern) that medics should know about, and we used facial images of hypothyroidism and Horner syndrome as examples.

We present a case of an 82-year-old woman presenting with left-sided Horner's syndrome and stroke. She also had a 6-week history of intermittent dizziness, reduced appetite, lethargy, muscle stiffness and weight loss. Examination revealed left temporal artery and left posterior auricular artery tenderness. Her ESR showed 62 mm/hr and imaging showed left vertebral artery dissection. Temporal artery biopsy was positive. The case highlights a rare presentation of giant cell arteritis with Horner's syndrome and left vertebral artery dissection. High clinical suspicion is required to prevent delay in diagnosis and treatment.