Horton & Horner

hortonSeveral neurophtalmic manifestations can occur with giant cell arteritis (GCA) or Horton disease. These are: blindness, transient or permanent
ophthalmoplegia, internuclear ophtalmoplegia and the Horner’s syndrome.
The association of GCA with Horner’s syndrome is a well known phenomenon but it is quite rare.
The Horner’s syndrome could be related to the damage of the sympathetic nerve fibers by the granulomatous inflammatory process of the wall of the internal carotid or more probably by ischemic damage of the vasa nervorum. By the way these are hypothesis which have not yet completely demonstrated.
It is very important to suspect GCA when the consultation concerns a patient with a new-onset Horner’s syndrome. This is especially true when the patient has also new onset headache, fatigue and increased VES. In this context it is mandatory to proceed to a biopsy of the temporal artery to confirm the diagnosis.
Recently, I saw a similar patient with the Horner’s syndrome and probable Horton disease. He was symptomatic since two weeks. The treatment with corticosteroids improved
considerably the headache in few days and the Horner’s syndrome disappeared! The results of the biopsy of the temporal artery are pending.

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