oculosympathetic pathway involved in Horner's syndrome:
- fibers from the hypothalamus go to the ciliospinal centre in the spinal cord at C8, T1 and T2.
- synapse.
- second-order neurones exit via the anterior ramus in the thoracic trunk.
- synapse in the superior cervical ganglion in the neck.
- 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.
A111218
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