When one more supine exercise in the gym ends the day as Horner syndrome

Abstract

Introduction: Horner syndrome remains challenging in daily clinical practice, as it can be related to a great variety of causes. It is a rare condition, classic manifestations include anisocoria with miosis, palpebral ptosis, and anhidrosis, all on the affected side due to the loss of sympathetic innervation. This case aims to describe an exercise-induced Horner syndrome and to state the importance of the patient´s clinical history, as well as a detailed physical exam, all put together in a multidisciplinary approach of a patient with Horner syndrome, in an emergency room setting.

Case description: 51-year-old male goes to the emergency room due to left palpebral miosis and homolateral hemifacial pain, following gym practice. In physical examination, he presented anisocoric pupils, with left miosis and palpebral ptosis. Blood tests including complete hemogram and chemistry were normal. As such, tomography angiography of the supra-aortic arteries and the brain was requested, which at first glimpse revealed no changes but following an image review, it was possible to detect a dissection in the internal left carotid artery. The patient started medical therapy with clinical resolution of the symptoms 24 hours from the moment he was admitted to the emergency room, having stayed under clinical surveillance for 48 hours.

Discussion: This clinical case is an example that, despite the diagnosis of a potentially fatal syndrome as is Horner’s syndrome, it is possible to have a favorable outcome with symptom resolution soon after clinical onset. For this to happen, several factors come into play, from a complete clinical history to a thorough physical exam and insightful use of the auxiliary exams available, all in a joint process of different medical specialties.