Horner's Syndrome

Question 1

Pathway associated with Horner’s

Answer 1

Sympathetic innervation to the eye
1. Ipsilateral Hypothalamus through the brain stem to T1/T2
2. Spinal cord to the superior cervical ganglion
3. Internal carotid artery to the orbit and dilator muscle of the iris

Question 2

Examination findings of horner’s

Answer 2

Miosis
Ptosis
Anhydrosis: upper quarter in 1st, face in 2nd, none in 3rd

Question 3

Causes of 1st order Horner’s

Answer 3

brain stem: stroke, tumour demyelination
spinal cord: syringomyelia, tumour, trauma

Question 4

Causes of 2nd order horner’s

Answer 4

lung apex: pan coast tumour
neck: tumour in cervical nodes, surgery, trauma, common carotid dissection

Question 5

Causes of 3rd order Horner’s

Answer 5

internal carotid dissection
cavernous sinus: thrombus, tumour
Orbit: tumour

Question 6

How would you investigate Horner’s?

Answer 6

Confirm horner’s: cocaine or hydroxyampethamine will exagerate anisocoria in 1st/2nd order horners, in 3rd order pupil will dilate. Apraclondine will cause dilation of affected pupil and other pupil may constrict.
Localise:
1st: MRI brain/spine
2nd: MRI neck, CXR, CT thorax, lymph node biopsy, carotid doppler
3rd: MRI neck, carotid doppler, MRI sinus/orbits

Question 7

How would you manage a patient with Horner’s?

Answer 7

Treat underlying cause
Manage ptosis: surgical correction