Intermittent Horner's syndrome: recurrent, alternate Horner's syndrome in cervical cord injury.

Ten patients with functional transection of the lower cervical cord were noted to develop a transient, occasionally alternate Horner syndrome. The ocular signs were rarely complete, eyelid droop being the most constant and prominent symptom. Signs could be elicited by turning the patients from side to side. They disappeared gradually with patients lying recumbent or supine. Cocaine and Adrenalin in the presently used concentration are not useful in diagnosis, but cocaine may possibly be used to "bring out" a "latent Horner's syndrome." The appearance of eye symptoms is delayed from 2 months to 7 years and, although implicating cavitation within the central gray, is not necessarily associated with progression of cord destruction rostrally or loss of remaining function. Temporary interference with sympathetic stimulation along the lateral tectotegmental tracts discharging to the intermediolateralis sympathetic column supplying the eye is suggested as responsible for this phenomenon. Fluid withdrawal from these cysts has been reported to revert the eye findings to normal and possibly arrest further cavitation.