Saturday, June 26, 2010

Horner's Syndrome

oculosympathetic pathway involved in Horner's syndrome:

  1. fibers from the hypothalamus go to the ciliospinal centre in the spinal cord at C8, T1 and T2.
  2. synapse.
  3. second-order neurones exit via the anterior ramus in the thoracic trunk.
  4. synapse in the superior cervical ganglion in the neck.
  5. third-order neurones travel from here with the internal carotid artery to the eye ( the pupil, the levator palpebrae) and the sweat glands of the face.

A lesion at any site along the pathway can produce Horner's syndrome.

Causes of Horner's syndrome:
1. carcinoma of the apex of the lung ( usually squamous cell carcinoma)

2. neck
- malignancy eg. thyroid
- trauma or surgery

3. lower trunk brachial plexus lesions
- Trauma
- Tumor

4. carotid arterial lesion
- carotid aneurysm or dissection
- pericarotid tumors (Raeder's syndrome)
- cluster headache

5. brainstem lesions
- vascular disease (especially the later medullary syndrome)
- tumor
- syringobulbia

6. syringomyelia (rare)

source: Talley

Thanks to Dr Ngiu for asking this question after bringing us to the patient with lateral medullary syndrome.



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