Horner's syndrome

Question 1

define Horner’s syndrome?

Answer 1

a condition that results from the disruption of the sympathetic nerves supplying the face in triad of:

partial ptosis

miosis- pupil constriction

anhydrosis- ipsilateral loss of sweating

Question 2

what are the causes of Horner’s syndrome?

Answer 2

caused by disruption of sympathetic nerves

• brainstem: demyelination, vascular disease, stroke
• cord:syringiomyelia
• Thoracic outlet: Pancoast tumour ( Apical lung tumour)
• on sympathetic’s trip on internal carotid artery into skull (carotid artery dissection)
• at orbit

Question 3

where do you get the symptoms of Horner’s?

Answer 3

IPSILATERAL SIDE TO LESION

Question 4

Describe the pathophyiology in terms of anatomy of Horner’s syndrome?

Answer 4

First order central SNS fibres arise from the hypothalamus, descend uncrossed through the midbrain and pons and terminate at the spinal cord level C8-T2

Second order preganglionic pupillomotor fibres exit the spinal cord at level T1 and enter the cervical sympathetic chain

The fibres ascend through the sympathetic chain and synapse in the superior cervical ganglion at level of the bifurcation of common carotid artery (C3-4).

Postganglionic fibres exit the superior cervical ganglion – some fibres branch off and travel along the external carotid artery to innervate blood vessels and sweat glands of the face

The third order pupillomotor fibres ascending along the ICA enter the cavernous sinus.

Question 5

summarise the epidemiology of Horner’s syndrome?

Answer 5

RARE

Important sign that is associated with various diseases (most notably, Pancoast tumours)

Question 6

what are the presenting symptoms of Horner’s syndrome?

Answer 6

inability to open eye fully on affected side

loss of sweating on affected side

facial flushing

orbital pain/ headache

Question 7

what are the signs of Horner’s on physical examination?

Answer 7

Ptosis

Miosis

Anhydrosis

Enophthalmos

Question 8

what are the appropriate investigations for Horner’s?

Answer 8

Investigations are directed towards figuring out the underlying cause

CXR - apical lung tumour

CT/MRI - cerebrovascular accidents

CT angiography - dissection

Question 9

what is the management plan, treatment and prognosis for Horner’s syndrome?

Answer 9

Dependent on cause