Horner syndrome, a rare disorder, occurs indiscriminately among all genders and races. Over 65% of all cases of Horner’s syndrome are related to birth injuries.
What is Horner’s Syndrome?
Horner syndrome occurs when there’s a problem with the nerve pathway connected to the eye and face. The most noticeable features of Horner syndrome are drooping of the eyelid, constriction of the pupil size, and the absence of normal sweating on the affected side of the face.
The eyelid droops because the nerve supply to a muscle called Müller’s muscle is disrupted. Similarly, the lower eyelid can slightly raise (reverse ptosis), making the eye-opening appear smaller. Additionally, since the nerve that normally controls pupil enlargement is affected, the pupil stays small, especially in low light, due to the unbalanced action of the opposing nerve, which makes the pupil smaller.
What Causes Horner’s Syndrome?
Horner’s syndrome is caused explicitly by an interruption of the sympathetic nerve fibers which run down from the brain on either side of the face and connect with the eyes.
Many different things including certain kinds of stroke and carotid artery injuries can potentially cause the interruption of these nerve fibers.
However, the leading cause of Horner’s syndrome is physical damage and injury to the nerve pathway caused by childbirth trauma.
Horner’s Syndrome Due to Birth Trauma
Physical injury or trauma during childbirth is the most common cause of Horner’s syndrome. Well over half of all Horner’s syndrome cases are related to birth injuries.
There are many different situations or medical mistakes during childbirth that damage a baby’s sympathetic nerve fibers and cause Horner’s syndrome or other conditions. Obstetrical complications during vaginal deliveries, such as shoulder dystocia, breach position, and cephalopelvicand disproportion, usually require the doctors to intervene and maneuver the baby through the birth canal.
This is always a delicate process that requires a high degree of medical skill, training and judgment to be employed in a high-pressure, time-sensitive environment. The use of assistive techniques such as vacuum extraction or forceps can often cause excessive pressure, force, or lateral traction on the baby and potentially injure the nerve pathways and cause Horner’s syndrome.
Error in judgment, such as failing to perform a timely emergency c-section in response to fetal distress, can also result in injury to the sympathetic nerve fibers.
What Are the Symptoms of Horner’s Syndrome?
Horner’s syndrome is a combination of physical symptoms that appear when the pathway of the sympathetic nerves on one side of the face is disrupted. Usually first seen by a nurse, these characteristic symptoms of Horner’s syndrome are:
- Miosis – a chronic constriction of the pupil of the affected eye making it appear smaller than the other eye’s pupil.
- Ptosis – a persistent drooping of the upper eyelid. Sometimes the lower eyelid may appear elevated (“upside-down ptosis”).
- The affected eye may also have a sunken or deep-set appearance compared to the other eye.
- Lack of normal sweating (anhidrosis) only on the affected side of the face.
- The pupil of the affected eye may show very little or slow dilation in dim light.
- In babies under 12 months Horner’s syndrome may result in one eye having a somewhat lighter color than the other.
Diagnosing Horner’s Syndrome
Diagnosis usually involves a clinical examination and may require imaging studies like MRI or CT scans to determine the exact cause and location of the injury. Treatment of Horner’s Syndrome resulting from a car accident focuses on addressing the underlying cause of the nerve damage.
The Prognosis for Horner’s Syndrome
The prognosis depends on the severity and type of the trauma as well as the timeliness and effectiveness of the treatment. In some cases, if the nerve damage to the infant is minor, the symptoms of Horner’s Syndrome may partially or fully resolve over time. However, in cases of severe trauma, the symptoms might be permanent.
How Is Horner’s Syndrome Diagnosed in Infants?
The pediatrician will likely identify the initial signs of Horner’s syndrome in a baby from observation and physical exam. If there are sufficient indications of Horner’s syndrome, your pediatrician may use eye drops to dilate the pupils and see if they respond normally to light stimulation. The next and final step in diagnosis may be an MRI, which can help to identify specific birth injuries that may have resulted in the condition.
What is the Treatment for Horner’s Syndrome?
Treatment options for Horner’s syndrome largely depend on the condition’s specific cause. Unfortunately, when Horner’s syndrome is the result of a birth injury the options for effective treatment are more limited. There are still options for treating and managing the condition with a newborn with medications and sometimes surgery.
The long-term prognosis of infants with Horner’s syndrome may also vary depending on severity and whether it is diagnosed early on. In some babies, the condition may simply go away on its own or with treatment.
Horner’s Syndrome Medical Malpractice Lawsuits
Medical malpractice lawsuits related to Horner’s syndrome are relatively uncommon. But they can arise when healthcare providers fail to meet the standard of care, resulting in patient harm. When there is a viable claim, it is usually a severe case with grave injury to the child.
Horner’s syndrome can be caused by medical errors or negligence in various contexts. Here are the three most common examples:
- Medical Procedures: Mismanagement or errors during surgical procedures involving the neck or chest can damage the sympathetic nerves responsible for Horner’s syndrome.
- Anesthesia Errors: Improper anesthesia administration, especially in neck surgeries, can lead to nerve damage and Horner’s syndrome.
- Incorrect Diagnosis or Treatment: Failure to diagnose and treat underlying conditions that can cause Horner’s syndrome, such as tumors or spinal cord injuries, may be medical malpractice if it results in harm to the patient.
Horner’s Syndrome as a Sign of Other Birth Injuries
Horner’s syndrome itself may not be a very serious or disabling condition. However, if a baby is born with Horner’s syndrome it may be an indication of significant trauma during childbirth that might have caused more severe injuries. Horner’s syndrome could be the first indication of birth injuries like Erb’s palsy or Klumpke’s palsy – both of which can be caused by the same type of birth trauma that causes Horner’s syndrome.
Horner’s Syndrome in Car Accidents
Horner’s Syndrome is a neurological condition that can sometimes occur as a result of a car accident, particularly if the accident results in neck or head trauma. People sometimes view Horner’s Syndrome as a disease. It is not. The fact that car crashes can cause Horner’s reminds us that Horner’s Syndrome is not a disease but a sign of an underlying problem that has affected the sympathetic nerves. Our lawyers have seen car and truck accidents where the condition is caused by direct physical trauma, whiplash injuries, or even penetrating injuries that damage the neck or chest area.
In the context of a car accident, the trauma might involve injury to the carotid artery (a major artery in the neck), cervical spine (neck vertebrae), or the base of the skull, all of which can disrupt the oculosympathetic pathway. This nerve route runs from the hypothalamus in the brain down the spinal cord and then up to the face and eyes.
Horner’s Syndrome Verdicts & Settlements
$2,000,000 Verdict (Illinois): During delivery, a female newborn experienced a severe and permanent brachial plexus injury, resulting in shoulder dystocia, the development of a neuroma across her entire right brachial plexus, lesions in the cervical roots, and Horner’s Syndrome affecting her right eye. The plaintiff argued that the defendant applied excessive lateral traction to the baby’s head during delivery, did not properly monitor the fetal position, failed to adequately address the shoulder dystocia, was negligent in not performing a cesarean section, and did not adhere to the proper standard of medical care. The defendant, however, denied any wrongdoing, asserting that the risk of shoulder dystocia was low, a cesarean section was unnecessary, and their treatment of the plaintiff consistently met acceptable medical standards. An Illinois jury saw it differently and awarded $2 million to the family.
$350,000 Settlement (Texas): The plaintiff, an infant, suffered brachial plexus injury, right arm Erb’s palsy, and right Horner’s syndrome when her birth was assisted by the female defendant physician. The plaintiff’s parent contended that the defendant assisted in the birth in a negligent manner, failed to recognize the risk factors for shoulder dystocia, failed to prevent the complication, and failed to provide the proper standard of care.
$700,000 Settlement (Oregon): An newborn male sustained Erb’s palsy and Horner’s syndrome following his delivery by the defendant obstetrician. The defendant encountered shoulder dystocia during delivery and performed a forceps delivery, causing evulsion of the nerve roots and brachial plexus. The plaintiff contended that the defendant should have performed a sonogram to determine the size of the fetus, particularly in light of the plaintiff mother’s obesity, and that the unusually large size of the fetus warranted a Cesarean delivery.
$300,000 Settlement (California): The plaintiff claimed he suffered a right brachial plexus injury resulting in permanent paralysis of his right arm and Horner’s Syndrome during delivery attended by the defendants. The plaintiff contended the defendants were negligent in their care and treatment of him during labor and delivery and mismanaged his delivery by performing a vaginal delivery instead of a cesarean section despite a prolonged labor, macrosomia and impending shoulder dystocia.
$150,000 Settlement (Nevada): In this case a 35-year-old female sustained Horner’s syndrome to her right eye as a result of negligence during a surgical procedure. The defendant admitted to making a mistake but contested whether the plaintiff’s eye issues were related.
$16,5000 Settlement (Oregon): The plaintiff was injured in a motor vehicle collision resulting in various injuries including a concussion with headaches, Horner’s Syndrome, and facial and cranial nerve disorder. She settled for policy limits with the at-fault driver and then sought UIM damages from her own insurance company.
The Birth Injury Lawyers at Miller & Zois Can Help
If your baby has been diagnosed with Horner’s syndrome, there is a possibility that it may have been caused by medical malpractice during childbirth. It is also possible that your baby may have more severe injuries.
Miller & Zois birth injury lawyers can thoroughly investigate your case at no cost to you. We can determine exactly what happened and tell you whether you have a malpractice claim. Call 800-553-8082 today or get a free online consultation.