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1 Neuro Eye Diseases > Horners > Flashcards

Horners Flashcards

1
Q

Small pupil due to a muscle problem

Small pupil due to a neuromuscular problem

A

Ciliary spasm from anterior uveitis

Miotics (pilo) or senile miosis

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2
Q

3 ways to determine if pt has horners

A
  1. Definition- ptosis, miosis, anhydrosis.
  2. Cocaine/apraclonidine testing
  3. Dilation lag test
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3
Q

How is ptosis in horners different than ptosis in CN III palsy

A

Varies with the tie of day. May get worse later in the day.

Kearn’s lower lid sign= inverse ptosis. Important

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4
Q

Inverse ptosis

A

Kearn’s lower lid sign

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5
Q

Horners. What is the response to light and near?

A

Both are intact. However, aniso will be greater in dim than in bright light.

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6
Q

Why is anhydrosis (no sweating) an important factor in horners?

A

helpful in localizing the lesion!

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7
Q

Pt with horners
dropped w cocaine
Dropped with apraclonidine

A

Cocaine- Horners Pupil doesn’t dilate

Apraclonidine- Horners pupil dilates, reversal of aniso

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8
Q

How to perform the dilation lag test

A

Because the sympathetic nervous system is compromised, the pupil will dilate very slow. 5 seconds into the darkness, it will be a different diameter than 10 seconds in.

A normal pupil would reach max dilation after the lights are turned off.

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9
Q

Horners lesion can be located anywhere from where to where

A

Posterior hypothalamus to the eye.

Determine location by signs, symptoms, and pharm agents.

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10
Q

5 main locations that cause horners syndrome and names

A
  1. Spinal cord
    - Congenital
    - Phrenic nerve syndrome
  2. Brainstem
    - Wallenberg’s/Stroke in brain stem/Lateral Medullary Syndrome
    - Anterior medullary syndrome
  3. Neck
    - Carotid artery dissection
    - Vernets. External sheath of carotid. Scapula problems.
  4. Chest
    - Pancoasts
  5. Head
    - Cluster headaches
    - Otitis
    - Cavernous sinus
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11
Q

Congenital horners

A

other signs: Heterochromia(due to reduced tyrosinase activity- sympathetically innervated and creates melanin. Disruption to sympathetic nervous system = lighter pupil), straighter hair, klumpke’s paralysis

Damage at C7 and 8

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12
Q

Klumpke’s paralysis

A

Spinal birth injury, involved in congenital horners

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13
Q

Wallenberg’s syndrome/lateral medullary syndrome symptoms

A

May cause horners

  • Stroke in the brainstem at the posterior inferior cerebellar artery.
  • Vertigo, vomiting, nystagmus.
  • Contralateral deficit of pain and temp.
  • Inspi horners and loss of facial pain.
  • Saccadic dysmetria. Overshoot on side of horners.
  • Ask pt to look up
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14
Q

Anterior medullary syndrome

A

May cause horners.

-Horners in 1 eye, CN 4 palsy on the other side

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15
Q

Horners lesion locations. Describe loss of sweating

  1. Lesion pre cervical ganglion
  2. Post cervical ganglion
  3. At cervical ganglion
  4. At brainstem
  5. At spinal cord
A
  1. Loss of ipsi facial sweating
  2. Loss of ipsi forehead sweat
  3. Loss of face sweating
  4. Loss of entire half of body ipsi
  5. Loss of upper half of body
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16
Q

Think cluster headache if pt reports

A

Red eye, stuffy nose, headache

17
Q

Vernets syndrome

A

Drooped shoulder, winged scapula, cannot say La Yogurt.
Problem involving CN 9-12 + horners
External carotid sheath syndrome

18
Q

Which is more serious? Lesions in horners at first, second, or third order neurons?

A

People with 2nd degree are prob very ill

People with 3rd degree are prob more benign- cluster HA, migraines, head trauma.

19
Q

Central, pre and post ganglions involved in horners

A

Central- first order
pre- 2nd order
post-3rd order

1st: Spinal cord –> Superior cervical ganglion
2nd: Superior cervical ganglion –>ganglia
3rd: Ganglia–> Muscle

20
Q

What is the lesion if the horners lesion is central/first order?

A

Involving brain and spinal cord.

  • Brainstem glioma
  • Syringomyelia
  • Spinal cord tumor
  • Wallenberg/Lateral medullary syndrome/stroke
21
Q

What is the lesion if the horners lesion is post/third order?

A 
Cluster HA
otitis media
cavernous sinus
internal carotid artery
nasopharyngeal tumor
22
Q

Difference between Wallenberg and Fovilles syndrome

A

Wallenberg- Lesion at Posterior inferior cerebellar artery

Fovilles- Lesion at anterior inferior cerebellar artery

23
Q

Acquired horners syndrome in adults. Symtpoms and what likely caused it based on age?

A

35% due to neoplasia

Birth-20 years: Trauma
20-50 years: Neoplasia
50+ years: Malignant neoplasia

24
Q 
If horners lesion is located 
Neck
Spinal root 
Brainstem 
Intracranial

What is the likely cause/

A

Neck or chest- neoplasia/quiet
Spinal root- trauma
Brainstem- Vascular disease
intracranial- headache/painful

25
Q

Small pupil due to a brain problem and stages

A

Syphillis

Primary
Secondary
Latent
Tertiary- affects eyes.

26
Q

Tertiary syphilis- other involvement and symptoms

A
  1. Cardiovascular (80%)
  2. Gummy lesions 10%
  3. CNS involvement 10%
27
Q

4 types of clinical neurosyphilis

A

Meningitis
Meningovascular syphilis
Tabes Dorsalis (Syphilis in the posterior columns)
General paresis (dementia paralytic) (syphilis in the frontal lobe)
*Last 2 associated with AR

28
Q

Syphilis common locations

A 
Frontal lobe (General paresis) 
Brainstem (AR Pupil) 
Posterior dorsal column (Tabes dorsalis)
29
Q

Tabes Dorsalis

A

Syphilis damage of the posterior dorsal columns

  • Weird gait
  • Usually affects men
30
Q

General paresis

A

Syphilis damage of the frontal lobe

  • Generalized paralysis
  • Personality disorder
  • Memory disturbances
31
Q

How can syphilis affect the eye? 4 ways

A

Granulomatous uveitis
Iritis –> Atrophic iritis/iris atrophy
AR (involvement at brainstem)
Neurologic tonic pupil (Involvement at ciliary ganglion)

32
Q

6 criteria for AR pupil

A
  1. Pupil diameter small. Less than 2.5mm
  2. No pupil response to direct light, consensual response is absent too.
  3. Near response intact but brisk
  4. difficult to dilate in dim light
  5. Usually bilateral
  6. Aniso may be present
33
Q

Syphilis testing

A

Order VDRL blood test

  1. Non treponema test looks for indirect evidence.
  2. If positive, then confirm its syphilis with RPR test. Does not require a microscope to interpret. Agglutination= positive

*Positive test doesn’t mean active. May have had it in the past.

1 Neuro Eye Diseases (3 decks)

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