Original Articles Open access

Delayed traumatic Horner’s syndrome and lower trunk brachial plexus neurapraxia following penetrating neck injury: a case report

Authors

Published
16 June 2026
Section
Original Articles
DOI
10.4081/ecj.2026.14826

Abstract

Penetrating Neck Injuries (PNI) are uncommon but potentially life-threatening due to high density of vital neurovascular and aerodigestive structures within the cervical region. Neurological complications including Horner syndrome are rare but clinically significant and may present in a delayed manner. We report the case of a 14-year-old boy who sustained a penetrating neck injury following a motorcycle accident in which a side-mirror handle became lodged in the left side of his neck. Despite being conscious and hemodynamically stable on arrival, an elective intubation was performed for airway protection. Contrast-enhanced computed tomography demonstrated the trajectory of the foreign body without evidence of major vascular or aerodigestive injury. Surgical exploration with endoscopic assistance allowed safe removal of the foreign body. Postoperatively, the patient developed transient right upper limb weakness consistent with the lower trunk brachial plexus neuropraxia and delayed onset ipsilateral Horner syndrome. Both neurological deficits gradually resolved with conservative management. This case underscores the importance of systematic assessment of PNI including recognition of soft signs, appropriate use of imaging and intraoperative endoscopic evaluation. Delayed neurological complications likely secondary to transient compression or neuropraxia of the cervical sympathetic chain and adjacent neural structures. Vigilant multidisciplinary management of penetrating neck trauma is essential to prevent missed injuries and manage delayed uncommon neurological complications. Careful evaluation, appropriate imaging and timely surgical intervention are essential to optimize patient outcomes.

Keywords

References

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Author Biographies

  • Noor Dina Hashim, Department of Otorhinolaryngology–Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur; Department of Otorhinolaryngology–Head and Neck Surgery, Hospital Canselor Tuanku Muhriz, Kuala Lumpur

    Department of Otorhinolaryngology–Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

    ASSOCIATE PROFESSOR

  • Sai Guan Lum, Department of Otorhinolaryngology–Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur; Department of Otorhinolaryngology–Head and Neck Surgery, Hospital Canselor Tuanku Muhriz, Kuala Lumpur



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