首诊于眼科的成人非创伤性霍纳综合征临床特点及病因分析

Clinical characteristics and etiological analysis of adult non-traumatic Horner syndrome in first visting of ophthalmology

目的分析首诊于眼科的成人非外伤性、非医源性霍纳综合征(Horner syndrome,HS)的临床特点及病因。设计回顾性病例系列。研究对象2018年1月至2020年6月首诊于眼科的HS患者7例。方法回顾患者的临床及影像学资料,分析其临床表现特点,病变位置及病因。主要指标起病形式、HS三主征、其他临床表现及影像学检查结果。结果7例患者中6例男性,1例女性为垂体瘤卒中。发病年龄41~60岁。所有患者均有明显的神经眼科体征,突眼2例、动眼神经受累2例、外展神经受累2例、三叉神经第一支受累2例。6例急性或亚急性起病,1例慢性病程。双眼睑裂大小相差2~4 mm,瞳孔大小相差1~1.5 mm。颈交感神经三级神经元的病变累及颈内动脉和海绵窦3例,分别为恶性肿瘤、瘤卒中及动静脉瘘;均无颜面部汗腺分泌异常,有2例伴有明显的局部疼痛。二级神经元受累2例,均为恶性肿瘤,肺尖部病变和甲状腺病变累及颈总动脉各1例,有颜面部汗腺分泌异常,但均无疼痛及神经眼科、神经系统其他体征。交感神经通路一级神经元,即丘脑至颈8~胸2(脊睫中枢)通路病变2例,延髓梗死及神经系统脱髓鞘疾病各1例;均有颜面部汗腺分泌异常,并伴有明显神经系统其他阳性体征。结论首诊于眼科的非创伤性HS起病形式、症状及其他神经系统受损表现对疾病有重要的定位及定性诊断意义。详细的神经眼科查体及早确认体征对于恶性肿瘤疾病、侵袭动脉及海绵窦的HS尤为重要。

Objective To analyze the clinical features and etiology of non-traumatic and non-iatrogenic Horner syndrome(HS)in adults.Design Retrospective case series.Participants From January 2018 to June 2020,hospitalized 7 patients with HS were collected in Beijing Tongren Hospital.Methods Their clinical and imaging data of characteristics,location and etiology of the disease were reviewed and analyzed.Main Outcome Measures The patient's onset form,HS three main signs,other clinical manifestations,imaging and other examination results.Results There were 6 males and 1 female with pituitary apoplexy.The age of onset ranged from 41 to 60 years.All patients had obvious neuro-ophthalmic signs,including exophthalmos in 2 cases,oculomotor nerve involvement in 2 cases,abducent nerve involvement in 2 cases,and the first branch of trigeminal nerve involvement in 2 cases.There were 6 cases of acute or subacute onset,1 case of chronic course.The difference in the size of the difference of fissure size was 2-4 mm,and the difference of the pupil was 1-1.5 mm.The lesions of the third-order neurons of the cervical sympathetic nerve involved the internal carotid artery and cavernous sinus was in 3 cases,including malignant tumor,apoplexy and arteriovenous fistula.The all 3 cases were no abnormal secretion of facial sweat glands,and 2 cases had obvious local pain.There were 2 cases of secondary neuron involvement,all of which were malignant tumors,1 case of pulmonary apex lesion and 1 case of thyroid lesion involving common carotid artery.There were abnormal secretion of facial sweat glands,but there were no pain and other signs of neuro ophthalmology and nervous system.There were 2 cases of pathological changes in the first level neurons of sympathetic pathway,which was from thalamus to cervical 8 or thoracic 2(spinal ciliary center).1 case was medulla oblongata infarction and 1 case was demyelinating disease of nervous system.All patients had abnormal secretion of facial sweat glands and other positive signs of nervous system.Conclusion The onset form,symptoms and other manifestations of nervous system damage of non-traumatic HS play very important roles in the localization and qualitative diagnosis of the disease.Detailed neuro-ophthalmic examination and early confirmation of physical signs are particularly important for the diagnosis of malignant tumor disease,invasive artery and cavernous sinus with HS.