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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