Horners

Question 1

what is it?

Answer 1

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

Ptosis
Anhydrosis
Miosis
(and enophthalmos)

Question 2

casues/aetiology?

Answer 2

Strokes
Multiple sclerosis
Apical lung tumours - Pancaost tumours

Lymphadenopathy
Basal skull tumours
Carotid artery dissection
Neck trauma

Question 3

which tumour is horner’s syndrome an important sign of?

Answer 3

pancoast tumour

Question 4

other presenting symptoms apart from PAM (signs)

Answer 4

Inability to open the eye fully on the affected side

Loss of sweating on affected side

Facial flushing

Orbital pain/headache

Other symptoms based on CAUSE

Question 5

ivx for horners?

Answer 5

Investigations are directed towards figuring out the underlying cause

CXR - apical lung tumour

CT/MRI - cerebrovascular accidents

CT angiography - dissection

Question 6

management for horners?

Answer 6

Horner’s syndrome is a sign not a disease in itself

So, the management depends on the cause (e.g. management for carotid dissection is very different to management of apical lung tumours)

Question 7

what is the nerve pathophysiology of horners?

Answer 7

Horner syndrome is due to a deficiency of sympathetic activity.

The site of lesion to the sympathetic outflow is on the ipsilateral side of the symptoms.

First-order neuron disorder: Central lesions that involve the hypothalamospinal tract (e.g. transection of the cervical spinal cord).

Second-order neuron disorder: Preganglionic lesions (e.g. compression of the sympathetic chain by a lung tumor) that releases acetylcholine.

Third-order neuron disorder: Postganglionic lesions at the level of the internal carotid artery (e.g. a tumor in the cavernous sinus or a carotid artery dissection) that releases norepinephrine.

Question 8

differentials for acute ptosis?

Answer 8

Horner’s Syndrome
Ocular Myasthenia
Third nerve palsy