Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Horner syndrome secondary to Hodgkin lymphoma

Andrew Micieli, Zeina Ghorab and Jonathan A. Micieli
CMAJ February 24, 2020 192 (8) E187; DOI: https://doi.org/10.1503/cmaj.190910
Andrew Micieli
Division of Neurology (A. Micieli, J. Micieli), Department of Medicine, University of Toronto; Department of Laboratory Medicine and Molecular Diagnostics (Ghorab), Sunnybrook Health Sciences Centre, and Department of Ophthalmology and Vision Sciences (J. Micieli), University of Toronto; Kensington Vision and Research Centre (J. Micieli), Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Zeina Ghorab
Division of Neurology (A. Micieli, J. Micieli), Department of Medicine, University of Toronto; Department of Laboratory Medicine and Molecular Diagnostics (Ghorab), Sunnybrook Health Sciences Centre, and Department of Ophthalmology and Vision Sciences (J. Micieli), University of Toronto; Kensington Vision and Research Centre (J. Micieli), Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jonathan A. Micieli
Division of Neurology (A. Micieli, J. Micieli), Department of Medicine, University of Toronto; Department of Laboratory Medicine and Molecular Diagnostics (Ghorab), Sunnybrook Health Sciences Centre, and Department of Ophthalmology and Vision Sciences (J. Micieli), University of Toronto; Kensington Vision and Research Centre (J. Micieli), Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

A previously healthy 31-year-old woman presented to the ophthalmology clinic with a 2-month history of left ptosis. She also reported a dry cough, non-exertional dyspnea and anhidrosis on the left side of her face. On examination, her vital signs were normal, and she had mild left ptosis and anisocoria, which was worse in dim lighting conditions, with a smaller left pupil (Figure 1A). The patient was also found to have bulkiness throughout the left cervical and supraclavicular area, diminished breath sounds and dullness to percussion on the left. Computed tomography of the chest showed a large left anterior mediastinal mass with extension into the left supraclavicular region and left upper lobe (Figure 1B). The appearance of the mass was highly suggestive of a lymphoproliferative disease, and biopsy confirmed the diagnosis of Hodgkin lymphoma (Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.190910/-/DC1). The patient received treatment with ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine and dacarbazine) chemotherapy and radiation (1000 cGy in 5 fractions) to the mediastinum, resulting in disease remission. At an 18-month follow-up, the left ptosis and anisocoria remained stable.

Figure 1:
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1:

(A) Photograph showing left mild ptosis and miosis in a 31-year-old woman. (B) Computed tomography scan of the chest showing a large left mediastinal mass (*) with extension into the left supraclavicular region and left upper lobe.

Horner syndrome, also known as oculosympathetic paresis, is a result of disruption of the sympathetic pathway that begins in the hypothalamus and takes a long course down the spinal cord to C8–T2, courses around the apex of the lung and ascends with the internal carotid artery before entering the orbit.1 Any patient with signs of Horner syndrome, including ptosis, miosis and anhidrosis, should have a thorough history and physical examination looking for associated neurologic signs, neck or respiratory symptoms, and orbital signs to help localize the lesion. This patient had prominent respiratory symptoms and signs, which were confirmed with imaging. Mediastinal lymphoma is a rare cause of Horner syndrome, but should be kept in the differential diagnosis because the respiratory symptoms may be absent or subtle.2,3 Imaging of the entire sympathetic pathway is recommended when no obvious cause is demonstrated from the history and physical examination.1

Footnotes

  • Competing interests: None declared.

  • This article has been peer reviewed.

  • The authors have obtained patient consent.

References

  1. ↵
    1. Reede DL,
    2. Garcon E,
    3. Smoker WR,
    4. et al
    . Horner’s syndrome: clinical and radiographic evaluation. Neuroimaging Clin N Am 2008;18:369–85.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Simon SR,
    2. Dorighi JA,
    3. Branda RF,
    4. et al
    . Horner’s syndrome: an unusual presentation of Hodgkin’s disease. Med Pediatr Oncol 1985;13:390–1.
    OpenUrlPubMed
  3. ↵
    1. Ruiz E,
    2. Resende LS,
    3. Gaiolla RD,
    4. Niéro-Melo L,
    5. et al
    . Post-ganglionic Horner’s syndrome: an unusual presentation of non-Hodgkin’s lymphoma. Case Rep Neurol 2012;4:43–6.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 192 (8)
CMAJ
Vol. 192, Issue 8
24 Feb 2020
  • Table of Contents
  • Index by author

Article extras

  • Videos

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Horner syndrome secondary to Hodgkin lymphoma
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Horner syndrome secondary to Hodgkin lymphoma
Andrew Micieli, Zeina Ghorab, Jonathan A. Micieli
CMAJ Feb 2020, 192 (8) E187; DOI: 10.1503/cmaj.190910

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Horner syndrome secondary to Hodgkin lymphoma
Andrew Micieli, Zeina Ghorab, Jonathan A. Micieli
CMAJ Feb 2020, 192 (8) E187; DOI: 10.1503/cmaj.190910
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Management of γ-hydroxybutyrate intoxication and withdrawal
  • Tuberculous monoarthritis of the knee joint
  • Vulvar condyloma lata as a first presentation of syphilis
Show more Practice

Similar Articles

Collections

  • Article Types
    • Clinical Images
  • Topics
    • Cancer & oncology
    • Cancer: respiratory system
    • Neurology
    • Ophthalmology

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

CMA Civility, Accessibility, Privacy

 

Powered by HighWire