(BMJ)—A 74-yo man presented w/ acute decompensated CHF. Drooping of R eyelid was noted. Past surgical hx: In 1970, he underwent open bilateral sympathectomy for craniofacial hyperhidrosis. Exam: R ptosis, miosis, and anhidrosis. What is the cause of his Horner syndrome?
Pancoast tumor
Right stellate ganglion injury
Brainstem stroke
Carotid artery dissection
Migraine
You are correct. This pt’s ptosis, miosis, and anhidrosis were due to iatrogenic injury to the stellate ganglion when he underwent sympathectomy for his hyperhidrosis. Sympathectomy is widely used to treat hyperhidrosis but now employs a minimally invasive thoracoscopic technique; consequently, Horner syndrome is now considered a rare complication. This pt’s ptosis occurred immediately post-op in 1970 but he declined corrective procedures.

BMJ Case Reports 2016; doi:10.1136/bcr-2016-217045