Case and Research Letters
Horner Syndrome: A Rare Complication of Cervical and Thoracic Herpes Zoster Infection
Síndrome de Horner: una rara complicación del herpes zóster cérvico-torácico
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Lobato-Berezo, M.T. Estellés-Pals, M.Á. Gallego-Valdés, R. Torres-Perea" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Lobato-Berezo" "email" => array:1 [ 0 => "allobe@hotmail.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.T." "apellidos" => "Estellés-Pals" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M.Á." "apellidos" => "Gallego-Valdés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "Torres-Perea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Neurología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Medicina Interna, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Horner: una rara complicación del herpes zóster cérvico-torácico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 458 "Ancho" => 1500 "Tamanyo" => 97925 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, The left eye shows miosis, ptosis of the upper eyelid, and greater dryness of the skin (the characteristic triad of Horner syndrome). B, Ocular signs resolved.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Postherpetic neuralgia is the most frequent and best-known complication of herpes zoster. Lesser-known complications include encephalitis, meningitis, and peripheral motor paralysis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Horner syndrome (miosis, ptosis, enophthalmos, and/or anhidrosis) is a rare complication of cervical and thoracic herpes zoster.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 74-year-old woman who presented to our emergency department with a 10-day history of progressively appearing painful lesions on her left arm, left chest, and left upper back. Past history included hiatal hernia and endometrial adenocarcinoma treated 11 years earlier with total hysterectomy, bilateral adnexectomy, bilateral pelvic and para-aortic lymphadenectomy, and adjuvant radiotherapy. She reported no systemic symptoms and no motor symptoms involving the arm. Physical examination revealed clustered vesicles and bullae on an erythematous base with some areas of surface erosion, in a C8 and T1 dermatomal distribution on the left side (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In addition, the patient had ptosis of the left upper eyelid; her left pupil was smaller than the right, and her skin was drier on the left side of her face (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A), with no other focal neurologic abnormalities. Biochemistry, a complete blood count, and a chest radiograph yielded no findings of interest. The patient was diagnosed with cervical and thoracic herpes zoster associated with Horner syndrome of the left eye. Antiviral therapy was initiated with 1<span class="elsevierStyleHsp" style=""></span>g of valacyclovir every 8<span class="elsevierStyleHsp" style=""></span>hours for 7 days, together with an alternating regimen of 1<span class="elsevierStyleHsp" style=""></span>g of acetaminophen every 8<span class="elsevierStyleHsp" style=""></span>hours and 575<span class="elsevierStyleHsp" style=""></span>mg of metamizole every 8<span class="elsevierStyleHsp" style=""></span>hours for pain. The skin lesions gradually improved, and Horner syndrome resolved within 15 days with no sequelae (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The best-described ocular complications of herpes zoster include swelling of the eyelid, keratitis, conjunctivitis, iridocyclitis, episcleritis, retinal necrosis, central retinal artery occlusion, and ophthalmoparesis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Horner syndrome, or oculosympathetic palsy, is characterized by ptosis, miosis, anhidrosis, and/or enophthalmos, and was classically attributed to space-occupying lesions in the vertex of the lung, such as Pancoast tumor. It has seldom been described as an ophthalmic or thoracic complication of herpes zoster.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the spinal cord, the ocular sympathetic pathway originates in the cells of the intermediolateral cell column at the level of segments C8 to T2. Preganglionic fibers emerge from the spinal cord following the ventral roots to form the sympathetic chain, pass through the stellate ganglion, and synapse in the superior cervical ganglion.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Given that the agent of herpes zoster infection lies dormant in the dorsal roots of the sensory ganglia of the central nervous system, the most plausible theory for the pathogenesis of Horner syndrome secondary to thoracic herpes zoster is that either the spinal cord or its ventral roots become inflamed owing to viral activation that spreads by contiguity.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a> However, in the case of herpes zoster ophthalmicus, other potential mechanisms have been considered, including ischemic neuritis of the third, fourth, or sixth cranial nerves; a mesencephalic lesion caused by axonal spread of the virus; inflammation by contiguity leading to myositis; or even immune-mediated demyelination due to local or remote viral spread.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Our search of the literature for herpes zoster associated with Horner syndrome revealed 11 reported cases (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) of patients aged 24 to 79 years, including 7 men and 4 women. Horner syndrome was associated with herpes zoster involvement of branches of the fifth cranial nerve in 5 cases,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> and with involvement of cervical and/or thoracic dermatomes in 6 cases. The right side was involved in 7 cases and the left side in 4. Most patients received antiviral therapy (acyclovir or famciclovir). However, Horner syndrome persisted for weeks or years in 6 cases, while recovery was partial in 2 cases and complete in 2 others.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a> None of the authors discuss potential factors predicting the persistence of Horner syndrome after herpes zoster resolution. In our view, early antiviral treatment, whether oral or intravenous, reduces the risk of persistence over weeks or years.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">We have reported a new case of Horner syndrome as a rare complication of cervicothoracic herpes zoster. This case is significant in that it underscores the need for dermatologists to examine patients for Horner syndrome and recognize it, in order to initiate early antiviral treatment to prevent other ocular complications and so that neurologists and/or ophthalmologists can be involved in a multidisciplinary management approach.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lobato-Berezo A, Estellés-Pals MT, Gallego-Valdés MÁ, Torres-Perea R. Horner Syndrome: A Rare Complication of Cervical and Thoracic Herpes Zoster Infection. Actas Dermosifiliogr. 2015;106:595–597.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 617 "Ancho" => 926 "Tamanyo" => 79605 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Vesicles and bullae forming herpetiform clusters on an erythematous base in the C8-T1 dermatomal distribution on the left side.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 458 "Ancho" => 1500 "Tamanyo" => 97925 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, The left eye shows miosis, ptosis of the upper eyelid, and greater dryness of the skin (the characteristic triad of Horner syndrome). B, Ocular signs resolved.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age, y \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dermatome \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Side \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Course \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Jarrett, 1967 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Trigeminal, V2-V3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Topical analgesics and antibiotics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cleared within 3 weeks \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Wimalaratna, 1987 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T2-T3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">— \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Persisted \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Smith, 1993 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Trigeminal, V1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acyclovir, 800<span class="elsevierStyleHsp" style=""></span>mg 5 times a day, 5 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Persisted after 1 month \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Tola-Arribas, 1997 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Trigeminal, V1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acyclovir, 800<span class="elsevierStyleHsp" style=""></span>mg 5 times a day, 5 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Persisted after 9 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Poole, 1997 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T3-T4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acyclovir, 200<span class="elsevierStyleHsp" style=""></span>mg 5 times a day, 5 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Persisted after 3 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gabriel, 2003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">C7-T1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral acyclovir \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Persisted after 3 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">C8-T1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Oral famciclovir \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Persisted after 10 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Agudo, 2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">T2-T3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Topical acyclovir \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">— \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pandey, 2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Trigeminal, V1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acyclovir, 800<span class="elsevierStyleHsp" style=""></span>mg 5 times a day for 3 weeks, and prednisone, 80<span class="elsevierStyleHsp" style=""></span>mg a day in tapering doses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improved after 3 weeks \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sedehizadeh, 2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">C3-C4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intravenous acyclovir and dexamethasone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cleared in 12 weeks \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Falzon, 2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Trigeminal, V2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intravenous acyclovir, 10<span class="elsevierStyleHsp" style=""></span>mg/kg every 8<span class="elsevierStyleHsp" style=""></span>hours \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Improved after 3 weeks \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab873578.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Reported Cases of Horner Syndrome Associated with Herpes Zoster.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Herpes zoster of second and third segments causing ipsilateral Horner's syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.S. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 15 | 7 | 22 |
| 2024 Octubre | 137 | 60 | 197 |
| 2024 Septiembre | 141 | 53 | 194 |
| 2024 Agosto | 173 | 96 | 269 |
| 2024 Julio | 154 | 62 | 216 |
| 2024 Junio | 155 | 58 | 213 |
| 2024 Mayo | 187 | 55 | 242 |
| 2024 Abril | 127 | 36 | 163 |
| 2024 Marzo | 131 | 39 | 170 |
| 2024 Febrero | 173 | 68 | 241 |
| 2024 Enero | 114 | 37 | 151 |
| 2023 Diciembre | 109 | 28 | 137 |
| 2023 Noviembre | 121 | 38 | 159 |
| 2023 Octubre | 181 | 50 | 231 |
| 2023 Septiembre | 143 | 41 | 184 |
| 2023 Agosto | 105 | 29 | 134 |
| 2023 Julio | 129 | 54 | 183 |
| 2023 Junio | 107 | 38 | 145 |
| 2023 Mayo | 127 | 57 | 184 |
| 2023 Abril | 101 | 27 | 128 |
| 2023 Marzo | 112 | 34 | 146 |
| 2023 Febrero | 60 | 20 | 80 |
| 2023 Enero | 71 | 50 | 121 |
| 2022 Diciembre | 104 | 46 | 150 |
| 2022 Noviembre | 45 | 31 | 76 |
| 2022 Octubre | 45 | 37 | 82 |
| 2022 Septiembre | 46 | 57 | 103 |
| 2022 Agosto | 51 | 65 | 116 |
| 2022 Julio | 47 | 48 | 95 |
| 2022 Junio | 50 | 49 | 99 |
| 2022 Mayo | 100 | 51 | 151 |
| 2022 Abril | 147 | 68 | 215 |
| 2022 Marzo | 133 | 56 | 189 |
| 2022 Febrero | 114 | 45 | 159 |
| 2022 Enero | 106 | 58 | 164 |
| 2021 Diciembre | 57 | 52 | 109 |
| 2021 Noviembre | 73 | 65 | 138 |
| 2021 Octubre | 97 | 55 | 152 |
| 2021 Septiembre | 67 | 57 | 124 |
| 2021 Agosto | 95 | 34 | 129 |
| 2021 Julio | 60 | 43 | 103 |
| 2021 Junio | 60 | 63 | 123 |
| 2021 Mayo | 34 | 52 | 86 |
| 2021 Abril | 101 | 65 | 166 |
| 2021 Marzo | 82 | 38 | 120 |
| 2021 Febrero | 80 | 39 | 119 |
| 2021 Enero | 55 | 36 | 91 |
| 2020 Diciembre | 48 | 33 | 81 |
| 2020 Noviembre | 42 | 32 | 74 |
| 2020 Octubre | 35 | 24 | 59 |
| 2020 Septiembre | 58 | 27 | 85 |
| 2020 Agosto | 43 | 24 | 67 |
| 2020 Julio | 37 | 23 | 60 |
| 2020 Junio | 49 | 52 | 101 |
| 2020 Mayo | 32 | 49 | 81 |
| 2020 Abril | 28 | 32 | 60 |
| 2020 Marzo | 23 | 29 | 52 |
| 2020 Febrero | 2 | 14 | 16 |
| 2020 Enero | 4 | 9 | 13 |
| 2019 Diciembre | 8 | 37 | 45 |
| 2019 Noviembre | 3 | 19 | 22 |
| 2019 Octubre | 0 | 19 | 19 |
| 2019 Septiembre | 4 | 23 | 27 |
| 2019 Agosto | 4 | 13 | 17 |
| 2019 Julio | 4 | 20 | 24 |
| 2019 Junio | 6 | 38 | 44 |
| 2019 Mayo | 5 | 97 | 102 |
| 2019 Abril | 4 | 48 | 52 |
| 2019 Marzo | 4 | 20 | 24 |
| 2019 Febrero | 4 | 8 | 12 |
| 2019 Enero | 6 | 5 | 11 |
| 2018 Diciembre | 7 | 8 | 15 |
| 2018 Noviembre | 1 | 5 | 6 |
| 2018 Octubre | 13 | 0 | 13 |
| 2018 Septiembre | 6 | 5 | 11 |
| 2018 Agosto | 0 | 15 | 15 |
| 2018 Julio | 0 | 14 | 14 |
| 2018 Junio | 0 | 8 | 8 |
| 2018 Mayo | 0 | 5 | 5 |
| 2018 Abril | 0 | 12 | 12 |
| 2018 Marzo | 1 | 13 | 14 |
| 2018 Febrero | 48 | 7 | 55 |
| 2018 Enero | 55 | 7 | 62 |
| 2017 Diciembre | 73 | 16 | 89 |
| 2017 Noviembre | 42 | 16 | 58 |
| 2017 Octubre | 41 | 4 | 45 |
| 2017 Septiembre | 34 | 13 | 47 |
| 2017 Agosto | 38 | 26 | 64 |
| 2017 Julio | 23 | 22 | 45 |
| 2017 Junio | 32 | 41 | 73 |
| 2017 Mayo | 29 | 16 | 45 |
| 2017 Abril | 37 | 31 | 68 |
| 2017 Marzo | 10 | 23 | 33 |
| 2017 Febrero | 17 | 16 | 33 |
| 2017 Enero | 17 | 20 | 37 |
| 2016 Diciembre | 17 | 28 | 45 |
| 2016 Noviembre | 32 | 33 | 65 |
| 2016 Octubre | 23 | 31 | 54 |
| 2016 Septiembre | 0 | 11 | 11 |
| 2016 Agosto | 0 | 32 | 32 |
| 2016 Julio | 5 | 5 | 10 |
| 2016 Junio | 11 | 12 | 23 |
| 2016 Mayo | 11 | 10 | 21 |
| 2016 Abril | 0 | 5 | 5 |
| 2016 Marzo | 0 | 2 | 2 |
| 2016 Enero | 0 | 1 | 1 |
| 2015 Diciembre | 0 | 8 | 8 |
| 2015 Noviembre | 0 | 2 | 2 |
| 2015 Octubre | 0 | 2 | 2 |
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