Horner’s syndrome is most commonly caused by a Pancoast tumor (a type of lung cancer at the apex of the lung) invading sympathetic nerve pathways. Other cancers, including metastatic neck tumors (squamous cell carcinoma), thyroid cancer, neuroblastoma (in children), and mediastinal tumors, can also cause this condition by compressing nerves.

Can cancer cause Horner's syndrome?

Typically, second-order Horner syndrome is caused by tumours in the chest or neck, or surgery or other invasive procedures performed on the chest or neck. Horner syndrome from metastatic disease of the spine is exceedingly rare, but has been reported in the instance of primary lung cancer causing C8–T1 radiculopathy.

What causes Horner's syndrome in adults?

Causes of Horner Syndrome in Adults

• Carotid artery dissection, where the main artery in the neck tears.
• Stroke or blood vessel damage in the brain or neck.
• Tumors in the lung, chest, or neck that press on nerves.
• Injury to the neck or head from accidents or trauma.
• Complications during neck or chest surgery.

Can Horner's syndrome come and go?

If the underlying cause is a chronic (long-lasting) condition, such as multiple sclerosis, Horner syndrome may also be chronic. If it results from something temporary and treatable, such as an ear infection, it'll likely go away once the infection is treated.

What are the first signs of a Pancoast tumor?

In many cases, the first sign of a Pancoast tumor is a sharp pain in the shoulder or arm, which can be persistent and may worsen at night.

Pancoast Tumor & Horner Syndrome

What can be mistaken for a Pancoast tumor?

Differential diagnoses of masses in the apical chest include the following:

• Primary tumors of the thyroid, larynx, and pleura.
• Infectious disorders of the lung.
• Aneurysms of the subclavian vessels.
• Amyloid of pleura.
• Multiple myeloma.

Who gets Pancoast tumors?

Like most other lung cancers, Pancoast tumors are more often seen in men and older people, with the average age of diagnosis being between 60–70 years old.

What other conditions mimic Horner's?

It is essential to consider other conditions that may mimic Horner's Syndrome, such as:

• Third cranial nerve palsy.
• Cluster headaches.
• Migraine with aura.
• Thyroid eye disease.

Can Horner's syndrome be benign?

The syndrome can be benign if idiopathic or iatrogenic, however, it can also be predictive of a life-threatening event such as demyelinating inflammatory, infectious, vascular or neoplastic problems.

Can Horner syndrome be caused by thyroid?

Horner syndrome is an infrequent manifestation of thyroid disorders and benign etiologies are more often implied. Malignant thyroid neoplasms represent a rare cause of Horner syndrome. However, an appropriate and prompt diagnosis is paramount for timely treatment of rare thyroid malignancies.

Can stress cause Horner's syndrome?

Horner syndrome is a rare neurological condition characterized by a drooping upper eyelid, a constricted pupil, and decreased sweating on one side of the face. It is caused by damage to part of the sympathetic nervous system (which responds to dangerous or stressful situations).

Which nerve damage causes Horner's syndrome?

Horner syndrome is caused by damage to a certain pathway in the sympathetic nervous system. The sympathetic nervous system regulates heart rate, pupil size, perspiration, blood pressure and other functions that enable you to respond quickly to changes in your environment.

What kind of cancer causes eye problems?

Eye cancer (eye lymphoma, ocular melanoma, retinoblastoma): Tumors can develop in the eye and alter vision. For example, symptoms of ocular melanoma include floaters, a dark spot on the iris that grows, a change in the shape of the pupil, vision changes in one eye, or a loss of peripheral vision.

What are the early signs of nerve cancer?

They include:

• Swelling or a lump under the skin.
• Pain, tingling or numbness.
• Weakness or a loss of function in the affected area.
• Dizziness or a loss of balance.

What tumor causes Horner's syndrome?

Common tumor-associated causes of acquired Horner's syndrome include Pancoast tumor, metastasis to cervical lymph nodes, and malignant pleural mesothelioma [8]. It may be caused by extension of the tumor into the paravertebral sympathetic nerves and/or pressure on the sympathetic plexus.

What test confirms Horner syndrome?

Apraclonidine testing can easily confirm the diagnosis of Horner's syndrome, but is unable to localize the lesion. Due to the long course of the oculosympathetic pathway from hypothalamus to the eye, there are multiple locations of potential pathology in Horner's syndrome.

Can MS cause Horner's syndrome?

64% of the MS clinic patient population develops a Horner's syndrome each year, and the prevalence of the syndrome in the current MS patient population is 2.3%.

Which artery is associated with Horner's syndrome?

Spontaneous dissection of the internal carotid artery as a cause of Horner's syndrome has only been recognized in recent years. The authors describe three patients with this condition.

How to rule out Pancoast tumor?

The diagnosis of Pancoast tumor is based on a physical examination, imaging studies, and tissue biopsy. In many cases, a Pancoast tumor can be initially recognized by the presence of the symptoms of Pancoast syndrome. However, a Pancoast tumor can be present without causing the hallmark symptoms.

Will an MRI show a Pancoast tumor?

MRI scan (magnetic resonance imaging) – This type of imaging scan is usually the most accurate at identifying the extent of tumor involvement into the chest wall, nerves, vertebrae or blood vessels.

What mimics a Pancoast tumor?

Extraosseous spread of multiple myeloma is seen in less than 10% of cases and can mimic Pancoast tumor when in the upper thoracic region. However, laboratory findings, bone marrow examination, and biopsy from the lesion can confirm the diagnosis of multiple myeloma.

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