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February 1986

Horner's Syndrome due to Hypothalamic Infarction: Clinical, Radiologic, and Pathologic Correlations

Author Affiliations

From the Department of Neurology, Boston University School of Medicine, and the Neurovascular Unit, Boston Veterans Administration Medical Center. Dr Stone is now with the Brown University Program in Medicine at The Miriam Hospital, Providence, RI.

Arch Neurol. 1986;43(2):199-200. doi:10.1001/archneur.1986.00520020085030

The association of Horner's syndrome and internal carotid artery occlusion has been recognized for many years and is usually attributed to ischemic damage to the third-order sympathetic neurons caused by decreased blood flow to the vaso nervorum arising from the carotid.1 We had the opportunity to observe a patient who developed Horner's syndrome as a consequence of infarct of the hypothalamus. Radiologic and pathologic materials are presented. Pathophysiological mechanisms are discussed.

REPORT OF A CASE  A 67-year-old man was hospitalized two hours after the sudden onset of weakness of his right arm and inability to speak. On physical examination the patient was normotensive, with an irregular pulse rate of 75 beats per minute. His arm weakness had cleared, and he had a mild, nonfluent aphasia. The electrocardiogram showed an acute anterior wall myocardial infarction, and he developed runs of premature ventricular contractions that were successfully controlled with administration of lidocaine