Horner's Syndrome: A Complication Following Carotid Endarterectomy

Abstract

Extracranial nerve injury following carotid endarterectomy (CEA) has been the subject of numerous reports. Horner's syndrome has been associated with a number of disorders of carotid artery but has not been reported in the literature following CEA. Horner's syndrome is characterized by specific neurologic and ophthalmologic findings and has been associated with carotid artery dissection, occlusion, aneurysm, fibromuscular dysplasia, and carotid body tumor. The authors report a persistent ipsilateral Horner's syndrome that developed in a sixty-four-year-old woman following CEA. Since 1977, 290 CEAs have been performed by the authors, and this is the only instance of this complication. The anatomy of the sympathetic chain and a review of Horner's syndrome are pre sented. Several possible etiologies are proposed for this oculosympathetic defect following CEA.

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References

Thompson JE : Complications of carotid endarterectomy and their prevention. World J Surg 3:155-165, 1979.

Grimson B. , Thompson HS : Horner's syndrome: Overall view of 120 cases. In: Topics in Neuro-ophthalmology, ed. by Thompson HS , Danoff R , et al. Baltimore: Williams and Williams, 1979, pp. 151-156.

Bryant MF : Complications associated with carotid endarterectomy. Am Surg 42:665-669, 1976.

Woodburne RT : Essentials of human anatomy, ed. 2. New York: Oxford University Press, 1961.

Sears M. , Kier EL , Chavis XX : Horner's syndrome caused by occlusion of the vascular supply to sympathetic ganglia. Am J Ophthalmol 74:717-724, 1974.

Havelius Ulf , Hinfelt B. : Minor vessels leaving the extracranial internal carotid artery. Possible clinical implications. Neuro-ophthalmol 5:51-59, 1985.

Loewenfeld IE : "Simple central" anisocoria: A common condition, seldom recognized. Trans Am Acad Ophthalmol Otolaryngol 83:832-839, Sept/Oct, 1977.

Smith PG , Dyches TJ , Burde RM : Topographic analysis of Horner's syndrome. Otolaryngol—Head and Neck Surg 94:451-457, 1986.

Mokri B. , Sundt TM , Houser W. : Spontaneous internal carotid dissection, hemicrania, and Horner's syndrome . Arch Neurol 36:677-680, 1979.

10.

Monteiro Mlf , Coppeto JR : Horner's syndrome associated with carotid artery atherosclerosis. Am J Ophthalmol 105:93-94, 1988.

11.

Moore W. : Extracranial cerebrovascular disease. In: Vascular Surgery: A Comprehensive Review, ed. 2, ed. by Moore W. Orlando : Grune & Stratton, 1986, pp 621-678.

12.

Glaser JS : Neuro-ophthalmology. Hagerstown, Md.: Harper & Row, 1978.

13.

Cousins MJ , Bridenbaugh PO : Somatic blockade of head and neck. In: Neural Blockade , ed. by Cousins MJ , Bridenbaugh PO. Philadelphia: Lippincott, 1988, pp 533-558.