An Ancient Case of Horner Syndrome?

The National Archeological Museum in Athens houses this philosopher's head (Fig. 1). The artifact was retrieved in 1901 from the sea off the coast of the Greek Island of Antikythera. Also found in the same cargo, believed to have been shipped to Rome, were other parts of the statue, other relics, and the world-famous "Antikythera mechanism," an ancient Greek analogue computer used to predict astronomical events. The creator of the head sculpture is unknown, and no previous description of it has been found in literature; it could date back to 240 BCE circa.

Historical Note An Ancient Case of Horner Syndrome? Umberto Maggioni, MD, Ferdinando Maggioni, MD T he National Archeological Museum in Athens houses this philosopher's head (Fig. 1). The artifact was retrieved in 1901 from the sea off the coast of the Greek Island of Antikythera. Also found in the same cargo, believed to have been shipped to Rome, were other parts of the statue, other relics, and the world-famous "Antikythera mechanism," an ancient Greek analogue computer used to predict astronomical events. The creator of the head sculpture is unknown, and no previous description of it has been found in literature; it could date back to 240 BCE circa (1,2). According to historians, the head represents Cynic philosopher Bion of Borysthenes (c.375-c.250 BCE). Documentary sources about his life are scarce, and no major issue concerning his health has ever been reported (3). On view of the statue head, what immediately stands out is an anisocoria and a mild ptosis affecting the right eye (Fig. 1A, B). From these findings, we hypothesize that this statue could depict a man with at least a partial Horner syndrome (we cannot know for sure whether hemifacial anhidrosis was present on the right side). The interpretation of the darker area on the apex of the iris of the right eye (Fig. 1C arrow) is less clear. Could this represent a sectoral heterochromia that would endorse the Horner syndrome hypothesis even further and indicate chronicity? Alternatively, the dark area may represent material damage suffered by the artifact over time or in the context to the disastrous shipwreck in from which the statue was recovered. Other possible explanations might include an upper eyelid retraction of the left eye due to thyroid eye disease; FIG. 1. A. Full head. B. Close-up of the eyes, with evidence of anisocoria and ptosis in the right eye. C. Area of possible heterochromia iridis (arrow). Reprinted with permission from the National Archeological Museum of Athens (K. Xenikakis). Copyright from Hellenic Ministry of Culture and Sports/Archaeological Receipts Fund. University of Padua (UM), Padua, Italy; and Department of Neurosciences (FM), Headache Centre, University of Padua, Padua, Italy. The authors report no conflicts of interest. Address correspondence to Ferdinando Maggioni, MD, Department of Neurosciences, Headache Centre, University of Padua, Via Giustiniani 5, 35128 Padua, Italy; E-mail: [e-mail] 286 however, such cases generally would not involve anisocoria. Post-traumatic injury, of course, cannot be excluded. We believe that this may be one of the earliest depictions of Horner syndrome and suggests that some great neuroophthalmology may be housed in museums rather than in the medical literature. The syndrome likely represented Maggioni and Maggioni: J Neuro-Ophthalmol 2019; 39: 286-287 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Historical Note by this statue was named for Swiss ophthalmologist Johann Friedrich Horner in 1869, although it was previously described by other authors, including French physician Pourfour du Petit in 1727 and French physiologist Claude Bernard in 1852 (4). During your next museum visit, you may find that the eyes tell a great story! STATEMENT OF AUTHORSHIP Category 1: a. conception and design: F. Maggioni and U. Maggioni; b. acquisition of data: F. Maggioni and U. Maggioni; c. analysis and interpretation of data: F. Maggionia and U. Maggioni. Category 2: a. drafting the manuscript: F. Maggioni and U. Maggioni; b. revising it Maggioni and Maggioni: J Neuro-Ophthalmol 2019; 39: 286-287 for intellectual content: F. Maggioni and U. Maggioni. Category 3: a. final approval of the completed manuscript: F. Maggioni and U. Maggioni. REFERENCES 1. Dozio E. Il naufragio di Anticitera. Sulla nave dei capolavori. Archeologia Viva 2016;176:8-15. 2. Archaeology Hour Podcast Blog. Available at: https://archaeologyhour. com/category/greek-statuary/. Accessed December 20, 2018. 3. Dudley D. A History of Cynicism. London, UK: Methuen & Co Ltd; 1937:64-68. 4. Proctor C, Chavis P. Horner syndrome. J Neuroophthalmol 2013;33:88-89. 287 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.