Correspondence

Horner's Syndrome

N Engl J Med 1999; 341:57July 1, 1999

Article

To the Editor:

Firlik and Welch, in Images in Clinical Medicine (Jan. 28 issue),1 provided a nice example of the clinical and magnetic resonance imaging findings in a patient with the Brown–Séquard syndrome due to a stab wound of the left side of the neck. The primary injury was to the right side of the cervical spinal cord at C4. The authors, however, incorrectly attributed their patient's right-sided Horner's syndrome to “injury of the right intermediolateral cell column.” Horner's syndrome resulting from a cervical spinal cord injury at C4 would be a consequence of the interruption of descending sympathetic fibers within the cervical spinal cord that originate in the hypothalamus.2,3 The intermediolateral cell column (where these descending sympathetic fibers ultimately synapse) is present not at C4 (the level of their patient's injury) but only from T1 to L2.4

Steven L. Lewis, M.D.
Rush–Presbyterian–St. Luke's Medical Center, Chicago, IL 60612

4 References

1. 1

   Firlik AD, Welch WC. Brown-Séquard syndrome. N Engl J Med 1999;340:285-285
   Full Text | Web of Science | Medline

2. 2

   Patten J. Neurological differential diagnosis. 2nd ed. London: Springer, 1995.
   

3. 3

   Shen CC, Wang YC, Yang DY, Wang FH, Shen BH. Brown-Sequard syndrome associated with Horner's syndrome in cervical epidural hematoma. Spine 1995;20:244-247
   CrossRef | Web of Science | Medline

4. 4

   Gilman S, Newman SW. Manter and Gatz's essentials of clinical neuroanatomy and neurophysiology. 8th ed. Philadelphia: F.A. Davis, 1992.
   

Author/Editor Response

Dr. Firlik replies:

To the Editor: Dr. Welch and I appreciate the comments of Dr. Lewis. He correctly points out that our patient's Horner's syndrome was most likely caused by disruption of the sympathetic fibers descending from the hypothalamus in the midcervical spinal cord at the level of C4. The intermediolateral cell column is not present until these descending sympathetic fibers synapse lower in the spinal cord, from T1 to L2. Our patient's Horner's syndrome should be attributed, in general terms, to damage of the lateral column of the cervical spinal cord at C4, the location of these descending sympathetic fibers at the midcervical level.1

Andrew D. Firlik, M.D.
University of Pittsburgh Medical Center, Pittsburgh, PA 15213-2582

1 References

1. 1

   Carpenter MB, Sutin J. Human neuroanatomy. 8th ed. Baltimore: Williams & Wilkins, 1983:209-31.
   

Citing Articles (1)

Citing Articles

1. 1

   George A. Stouffer, Richard G. Sheahan, Daniel J. Lenihan, Paresh Patel. (2003) The Current Status of Immune Modulating Therapy for Myocarditis:. The American Journal of the Medical Sciences 326:6, 369-374
   CrossRef