Neuro

Question 1

Horner’s syndrome

Answer 1

Ptosis + Miosis + Anhydrosis

Causes:
1. Central - MS, SOL, Brainstem stroke (Wallenburg)
2. Preganglionic - Pancoast tumour
3. Post-ganglionic - Carotid artery dissection

Differentials for anisocoria
1. Horners
2. Surgical 3rd nerve palsy
3. Adie’s Tonic pupil

Question 2

Syringomyelia

Answer 2

Syrinx (fluid-filled cavity) forms within the central canal of spinal cord
This is secondary to disruption of CSF drainage from central canal. (Commonly due to Chiari malformation or trauma)

• Cape-like distribution of PAIN + TEMP loss
• Light touch + Vibration + Proprioception INTACT
• Flaccid atrophic paralysis in upper limbs

Differentials:
* Cervical disc prolapse
* Amyotrophic lateral sclerosis
* Multiple sclerosis

Diagnostic = MRI

Management

Conservative for most = Physio, Analgesia, Baclofen for spasticity

Surgical decompression for progressive disease or if tumour present