Zusammenfassung
Aufgrund der komplexen zugrundeliegenden Neuroanatomie vermag das Horner-Syndrom wie kaum ein anderes neurologisches Syndrom Ausdruck unterschiedlichst lokalisierter Läsionen im zentralen und peripheren Nervensystem zu sein. Diese Übersicht soll dazu dienen, Möglichkeiten einer raschen Eingrenzung der verursachenden Pathologie und die wichtigsten ätiologischen Mechanismen darzustellen. Dazu soll zunächst die Neuroanatomie der sympathischen Versorgung von Iris, Augenlid, Gefäßen und Schweißdrüsen des Gesichts dargestellt werden, wobei insbesondere neuere Befunde zur Topographie des zentralen Abschnitts berücksichtigt werden. Daneben wird auf pharmakologische Testverfahren und Untersuchungen der Schweißsekretion eingegangen, die die ätiologische Zuordnung erleichtern und die Wahl geeigneter, vor allem neuroradiologischer Zusatzdiagnostik ermöglichen. Zuletzt wird eine schematische Übersicht über die häufigsten pathologischen Mechanismen insbesondere unter Bezug auf begleitende klinische Symptome gegeben.
Abstract
Due to the complex neuroanatomy of the sympatho-excitatory pathway, Horner's syndrome represents a clinical sign that may result from a variety of lesions in the central and peripheral nervous system. The purpose of the present communication is to help the reader to localize the site of the lesion and to demonstrate the most common etiologic mechanisms resulting in Horner's syndrome. The functional anatomy of the sympathetic supply to the iris, eyelids, facial sweat glands and blood vessels is reviewed and in particular the structure of the central pathway updated. Moreover, pharmacological testing and tests of sudomotor function are described that may help to guide the decision regarding useful additional diagnostic, especially neuroimaging procedures. Finally, a schematic overview is given on the most common pathology, considering additional clinical signs and symptoms.
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Dr. med. Jürgen J. Marx
Klinik und Poliklinik für Neurologie
Langenbeckstr. 1
55101 Mainz
Email: marx@neurologie.klinik.uni-mainz.de
