Horner's Syndrome after Scalene Block and Carotid Dissection

Area of Science:

• Neurology
• Ophthalmology
• Emergency Medicine

Background:

• Horner's syndrome is characterized by the triad of ptosis, miosis, and anhidrosis.
• It results from disruptions in the ocular and facial sympathetic pathways.
• Diverse etiologies can cause Horner's syndrome, necessitating awareness of relevant anatomy for diagnosis.

Observation:

• Two patients with Horner's syndrome were treated at a Nashville-area hospital in 2014.
• Patient 1: A 26-year-old man developed symptoms post-orthopedic procedure, linked to anesthesia device.
• Patient 2: A 42-year-old man presented with headache and ptosis, diagnosed with carotid dissection.

Findings:

• Patient 1's symptoms resolved after anesthesia device deactivation.
• Patient 2 was admitted for management of carotid dissection.
• Neoplastic causes, like Pancoast tumors, are less common than other etiologies.

Implications:

• Emergency physicians must consider a broad range of causes for Horner's syndrome.
• Understanding the anatomy and diverse pathologies aids in timely diagnosis and treatment.
• Prompt recognition and management are crucial for conditions like cervical artery dissection.