Download horners syndrome

HORNERS SYNDROME:
1) PTOSIS
2) MIOSIS (CONSTRICTION)  still reacts to light
3) ANHYDROSIS: (forehead) only if lesion above carotid bifurcation,
(ie absence does not preclude Dx)
CAUSE: LESION IN OCCULO-SYMPATHETIC PATHWAY
= 3 NEURONE PATHWAY
(Does not cross sides along course)
1) CENTRAL:
Pathway: Hypothalamus  Brainstem  cervical cord synapses at cilio-spinal
centre of Budge (bet C8-T2).
Central Horner’s – usually NOT an isolated clinical finding
Often feature other brainstem/spinal Syx/Signs
CAUSES:
Stroke
Tumor
Syrinx
AVM
Trauma
Demyelination
Eg: LATERAL MEDULLARY SYNDROME (WALLENBERG’S SYNDROME)
Post Inf Cerebellar Art (PICA) ischaemia
Signs: Dysphagia
Ipsilateral facial anaesthesia
Contralateral trunk/limb anaesthesia
Ipsilateral cerebellar ataxia
Nystagmus (rotary/to side of lesion)
Usually Ix by MRI
2) PREGANGLIONIC
2nd order neurone:
From: cilio-spinal centre (cord)  T1 Root  Sympathetic chain (inf & middle symp
ganglia)  superior cervical ganglion
PATH DAMAGED BY:
T1 nerve root damage at birth (Clumpke palsy)
Compression at lung apex: Lung Ca (Pancoasts) Breast Ca, TB, cervical rib, vascular
anomaly (eg subclavian artery problem)
NB: Shoulder tip or arm pain if brachial plexus affected
This presentation requires CxR!
Neck Surgery |
Trauma
3) POSTGANGLIONIC
Superior cervical ganglion  carotid plexus  ascends with INTERNAL carotid 
cavernous sinus  join fibres of OPHTHALMIC branch of TRIGEMINAL nerve 
becomes LONG CILIARY NERVE
Reach pupil via branches of Ophth Div CN5:  DILATOR MUSCLE OF IRIS
Reach eyelids via branches of Ophthalmic Artery:  SMOOTH MUSCLE OF
UPPER & LOWER LID
Horners + NECK/FACIAL PAIN = CAROTID DISSECTION (MRA)
Horners + GAZE PALSY = CAVERNOUS SINUS
NB Cluster headaches can cause Horner’s