Horner's Syndrome Flashcards

1
Q

What is Horner’s syndrome?

A

It is defined as a condition in which there a lesion to the sympathetic chain supplying the eye

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2
Q

What three eye structures are innervated by the sympathetic nerve system?

A

Dilator pupillae

Superior tarsal muscle

Sweat glands

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3
Q

What is the function of the dilator papillae?

A

Pupil dilatation

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4
Q

What is the function of the superior tarsal muscle?

A

Elevation of the upper eyelid

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5
Q

What are the three classifications of Horner’s syndrome?

A

First Order Horner’s Syndrome

Second Order Horner’s Syndrome

Third Order Horner’s Syndrome

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6
Q

Which clinical feature can be used to differentiate between the classifications?

A

Anhidrosis

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7
Q

What is another term for first order Horner’s syndrome?

A

Central Horner’s syndrome

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8
Q

What is first order Horner’s syndrome?

A

It involves a lesion to the first order neurone - which spans from the hypothalamus to the T1 spinal cord segment

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9
Q

In first order Horner’s syndrome, which areas of the body are affected by anhidrosis?

A

Face

Arm

Trunk

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10
Q

What are the four causes of first order Horner’s syndrome?

A

Stroke

Multiple Sclerosis

Brain Tumour

Encephalitis

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11
Q

Which stroke syndrome is commonly associated with first order Horner’s syndrome?

A

Wallenberg’s syndrome

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12
Q

What artery is affected in Wallenberg’s syndrome?

A

The posterior inferior cerebellar artery

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13
Q

What are the five clinical features associated with Wallengerg’s syndrome?

A

Horner’s features

Ipsilateral ataxia

Dysphagia

Hoarseness

Reduced gag reflex

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14
Q

What is another term for second order Horner’s syndrome?

A

Pre-ganglionic Horner’s syndrome

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15
Q

What is second order Horner’s syndrome?

A

It involves a lesion to the second order neurone – which spans from the hypothalamus to the superior cervical ganglion, via the cervical sympathetic

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16
Q

In second order Horner’s syndrome, which areas of the body are affected by anhidrosis?

A

Face

17
Q

What are the four causes associated with second order Horner’s syndrome?

A

Pancoast Tumour

Cervical Rib

Thyroid Malignancy

Brain Trauma

18
Q

What is another term for third order Horner’s syndrome?

A

Post-ganglionic Horner’s syndrome

19
Q

What is third order Horner’s syndrome?

A

It involves a lesion to the third order neurone – which spans from the superior cervical ganglion to the cavernous sinus, where the sympathetic fibres join the ophthalmic nerve (V1)

20
Q

In third order Horner’s syndrome, which areas of the body are affected by anhidrosis?

A

There is no anhidrosis

21
Q

What are the four causes of third order Horner’s syndrome?

A

Carotid Artery Dissection

Carotid Aneurysm

Cavernous Sinus Thrombosis

Cluster Headache

22
Q

Does Horner’s syndrome affect the contralateral or ipsilateral side in comparison to the lesion site?

A

Ipsilateral

23
Q

What are the four clinical features of Horner’s syndrome?

A

Miosis

Ptosis

Anhidrosis

Enophthalmos

24
Q

What is miosis?

A

It is defined as pupil constriction

25
Q

What is ptosis?

A

It is defined as eyelid drooping

26
Q

What is anhidrosis?

A

It is defined as lack of sweating

27
Q

What is enopthalmos?

A

It is defined as a sunken eye

28
Q

What is a clinical feature specific to congenital Horner’s syndrome?

A

Iris heterochromia

This is defined as a difference in iris colour

29
Q

What are the two investigations used to diagnose Horner’s syndrome?

A

Alpha Adrenergic Agonist Eye Drops

Amphetamine Eye Drops

30
Q

Name an alpha adrenergic agonist eye drop used to investigate Horner’s syndrome

A

Apraclonidine

31
Q

How are apraclonidine eye drops used to investigate Horner’s syndrome?

A

They are used to confirm a diagnosis

32
Q

What apraclonidine eye drop results indicate a diagnosis of Horner’s syndrome? Explain this result

A

There is reversal of pupillary constriction - leading to pupil dilatation

This is due to its agonistic effect on alpha-2 receptors

33
Q

Name an amphetamine eye drop used to investigate Horner’s syndrome

A

Hydroxyamphetamine

34
Q

How are hydroxyamphetamine eye drops used to investigate Horner’s syndrome?

A

They are used to locate the lesion in Horner’s syndrome

35
Q

What hydroxyamphetamine eye drop results indicate a diagnosis of preganglionic (1st, 2nd order neurone) Horner’s syndrome?

A

Pupil dilatation

36
Q

What hydroxyamphetamine eye drop results indicate a diagnosis of postganglionic (3rd order neurone) Horner’s syndrome?

A

No pupil dilatation

37
Q

How do we manage Horner’s syndrome?

A

We treat the underlying cause