A Claud Bernard Horner syndrome: The malignancy of cervical shwanoma

Abstract

Schwannomas are benign tumors that originate exclusively from Schwann cells, which form the myelin sheath of peripheral nerves. Schwannomas most commonly affect the vagus nerve, although other cranial nerves may also be involved. Involvement of the cervical sympathetic nervous system is exceedingly rare. We report the case of 34-year-old man with no significant medical history. Since the age of 8 years, he had presented with a right upper cervical mass neglected by the patient. The patient had presented for 4 months prior to admission with recurrent infections associated with inflammatory swelling of the mass, febrile episodes and, more recently, the appearance of significant dysphagia and odynophagia. Magnetic resonance imaging with gadolinium contrast confirmed the presence of a well-defined, mass along the cervical sympathetic chain suggestive of a schwannoma developed at the expense of the cervical sympathetic chain. Surgical exploration revealed a homogeneous mass measuring 4.5 × 5 cm, displacing the internal jugular vein anteriorly and the vagus nerve medially, close to the carotid vessels. In the immediate postoperative period, the patient developed isolated right-sided Claude Bernard-Horner syndrome and symptomatic management included a 7-day course of antibiotics and analgesics, as well as eye lubricant drops for 14 days. The clinical course was favorable. Early and appropriate management is essential to optimize functional prognosis and improve the patient's quality of life.

Keywords: Cervical sympathetic nervous system; Horner’s syndrome; Imaging; Schwannoma; Surgical excision.

Fig. 1

Coronal contrast-enhanced T2-weighted MRI showing a homogeneous mass with T2 hypersignal, located in the deep retroparotid space, with anteromedial displacement of the internal carotid artery and anterolateral displacement of the internal jugular vein.

Fig. 2

Axial contrast-enhanced T1-weighted MRI showing a well-defined, heterogeneously enhancing mass on the right side of the neck, displacing the jugulocarotid axis anteriorly and laterally.

Fig. 3

Figure showing a right lateral cervicotomy for a cervical sympathetic schwannoma.

Fig. 4

Figure showing right eye ptosis postoperatively due to Claude Bernard-Horner syndrome. (Photo taken with patient’s consent).