title: Abducens nerve palsy and postganglionic Horner syndrome with or without severe headache.
abstract: OBJECTIVE
  To report the clinical features of 9 patients with both abducens nerve palsy and postganglionic Horner syndrome.
  
  
  METHODS
  Nine patients with this symptom combination were examined by our Neuro-ophthalmology Clinic in Nihon University Itabashi Hospital between 1978 and 2004. Patient ages ranged from 28 to 63 years (average 47.2+/-8.7 years). Six patients were males and 3 were females. Primary diseases, accompanying symptoms and prognoses were surveyed.
  
  
  RESULTS
  In primary diseases, neoplasm in the cavernous sinus was observed in 2 patients, sphenoidal sinus cyst in 2, intra-cavernous carotid aneurysm in 2, epipharynx carcinoma in 1, chordoma in the base of the skull in 1, and meningioma in the middle cranial fossa in 1. Five patients with extra-cavernous sinus lesions; sphenoidal sinus cyst, epipharynx carcinoma, chordoma and meningioma, complained of severe headache. However, in patients without severe headache, intra-cavernous sinus lesions such as carotid aneurysm and metastatic carcinoma were detected. After therapy, abducens nerve palsy improved in 5 patients, however, Horner syndrome persisted in all patients.
  
  
  CONCLUSIONS
  We emphasize that this symptom combination is an important sign of lesions in the posterior portion of the cavernous sinus or in its vicinity. Moreover, the presence or absence of severe headache depends on whether the lesion is in the intra-cavernous or extra-cavernous sinus.
authors.affiliation: Division of Neurology, Department of Medicine, Nihon University, School of Medicine, Tokyo.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Tsuda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Kishiro
authors.forename: Noriko
authors.initials: N
authors.lastname: Koga
authors.forename: Yoji
authors.initials: Y
authors.lastname: Kashima
mesh_terms: D020434:Abducens Nerve Diseases / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D000328:Adult; D002426:Cavernous Sinus / Q000503:physiopathology; D003131:Combined Modality Therapy; D005260:Female; D006261:Headache / Q000209:etiology*; D006732:Horner Syndrome / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008444:Maxillary Sinus Neoplasms / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D017779:Sympathetic Fibers, Postganglionic / Q000503:physiopathology*