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Horner Syndrome

Horner syndrome involves a combination of symptoms related to nerve damage and nerve disorders. Horner syndrome is often identified by signs in the eyes, including a constricted pupil or droopy eyelid. However, the problem may involve a number of underlying conditions that could be caused by other diseases or trauma. 

Childbirth can be traumatic, especially in a difficult or prolonged delivery. The parents are relieved to give birth to a healthy child but days, months, or even years later, they may notice some issues. This could include problems in the eyes, delayed development, or movement problems. Many birth injuries are not known immediately after delivery. It is only after the child begins to develop that the parents may notice the consequences of a delivery error. 

Traumatic birth injuries may be caused by medical negligence. When a doctor is responsible for causing nerve damage or other birth injuries, the doctor and hospital should be held liable for their mistakes. 

What is Horner Syndrome?

Horner syndrome is a neurological condition that usually involves drooping of the eyelids, constricted pupils, and loss of facial sweating. These symptoms are caused by a disruption in the sympathetic nerve supply, which connects the nerves in the face, head, and neck to the spinal cord.  

Horner syndrome, also called Horner’s syndrome, is usually identified in the eyes of someone with the condition, and sometimes in the head and face. There are a variety of causes of Horner syndrome, including disease, congenital defects, or head trauma. In some cases, the cause of Horner syndrome is unknown. 

Horner syndrome is not easy to identify from a simple observation and may require eye tests or diagnostic tests to make a confirmed diagnosis. Eye conditions alone may not be enough to cause serious injury or harm but Horner syndrome may be an indicator of other underlying conditions, including birth trauma or disease affecting the nervous system. 

Nerve Disorders in Newborns

Birth trauma to the neck or shoulder area may cause Horner syndrome in newborns. This is one of a number of nerve disorders that can affect children and newborns in childbirth or delivery. Nerve damage is a common birth injury that can cause nerve damage in the head, eyes, neck, or shoulder. These could cause temporary birth injury that leaves no permanent damage or more serious injury that leaves the child with a lifelong injury. 

Another common birth injury caused by brachial plexus nerve damage is shoulder dystocia. Also known as Erb’s palsy, it is damage to the upper nerves of the arm. This can leave a child with some ability to move fingers but not the shoulder. In other cases, the arm may be totally paralyzed. This kind of injury usually occurs in a difficult delivery, where a doctor uses too much force to deliver a baby, or improperly uses vacuum extractors or forceps during delivery. 

Signs and Symptoms of Horner Syndrome

The signs and symptoms of Horner Syndrome in children is usually noticed in the eyes, as well as the face, head, or hair. These signs may not be obvious and some people may not even notice anything out of the ordinary. Any symptoms should be evaluated by a doctor but sudden onset of symptoms after trauma may indicate other injury. Common signs include: 

  • Drooping upper eyelid (ptosis)
  • Constricted pupil (miosis)
  • Difference in pupil size (anisocoria)
  • Sinking eyeball
  • Bloodshot eye
  • Inability to fully open or close the eyelid
  • Loss of ciliospinal reflex (pupil dilation in response to pain)
  • Decreased facial sweating (anhidrosis)
  • Lack of flushing on one side of the face
  • Headache
  • Straight hair on one side of the head
  • Different eye color (heterochromia)

While these can all be signs of Horner syndrome, any of these or a combination of these signs alone is not enough for a diagnosis. For a diagnosis, imaging or eye tests are usually required to confirm the syndrome. 

Diagnosis with Eye Drop Test

An eye drop test can confirm the diagnosis of Horner syndrome by placing a drop in both eyes and comparing the reactions to determine whether there may be nerve damage. Historically, cocaine was used in the eye drop test. An eye drop test can also help show the site of neuron damage, with paredrine used for the eye drop test. If the damage is along the 3rd-order neuron, then the drops will have no effect and there may be no change in the constricted pupil. If there is a change, the damage may be along the 1st and 2nd order neurons. 

Diagnosis with MRI

Imaging may also help diagnose Horner syndrome and the location of the nerve damage. Depending on the symptoms and other factors, diagnostic tests may include: 

  • Magnetic resonance imaging (MRI)
  • Ultrasound
  • X-rays
  • Computerized tomography (CT)

What Causes Horner Syndrome?

Horner syndrome is caused by nerve damage. The nerve damage to the sympathetic nervous system can affect a number of processes in the body, including blood pressure, heart rate, and pupil size. The cause of Horner Syndrome may be based on where along the nerve pathway the injury or damage occurred. 

First-order neurons lead from the hypothalamus at the base of the brain to the upper section of the spinal cord. Second-order neurons go from the spinal column, up to the chest and side of the neck. Third-order neurons extend from the side of the neck to the facial skin and muscles of the eyes. Depending on where on the neural path the injury occurred (or if there are multiple injury sites), causes may include: 

  • Brain tumor
  • Encephalitis
  • Multiple sclerosis
  • Klumpke’s palsy
  • Thyroid cancer
  • Neck trauma
  • Aortic aneurysm
  • Ear infection
  • Headache
  • Stroke
  • Genetic disorders
  • Cyst on the spinal cord
  • Infection
  • Migraines
  • Congenital defect
  • Neuroblastoma
  • Traumatic birth injury

Treatment for Horner Syndrome

Treatment for Horner syndrome generally involves treating the underlying conditions. When the underlying conditions are treated, the symptoms of Horner syndrome may resolve on their own. However, because the symptoms can indicate other problems, it is important to get an evaluation for any symptoms, because it could be a sign of other neurological problems, birth trauma, cancer, or other conditions. 

Horner Syndrome Caused by Medical Errors 

There can be a number of causes of Horner Syndrome. However, in children, Horner Syndrome may be caused by birth trauma. Traumatic injury to the nerves can cause permanent damage, including Erb’s palsy or shoulder dystocia. This type of physical trauma can be caused by a doctor trying to rush delivery or failure to do an emergency C-section.

Doctors are supposed to follow a standard of care. When the doctor fails to provide a minimum standard of care which causes injury to the patient, the doctor may be liable for any damages. If a doctor made a mistake, delayed treatment, or failed to properly diagnose the pregnant mother or baby, the family may be able to get compensation for their losses. 

Nerve Disorder Malpractice Lawyers

Families may not know where to turn after a birth injury. The hospital may provide treatment options but not provide answers for what went wrong. By contacting an experienced birth injury attorney, you will have someone on your side to get to the bottom of what happened, find any medical errors, and help you recover damages to pay for your child’s care.

If you have questions about possible medical mistakes during delivery, talk to an experienced birth injury malpractice attorney about your options. Do not hesitate to contact Gilman & Bedigian today for a free consultation.

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