Sindromes

Question 1

Sindrome de Horner

Answer 1

1. Because of interruption of sympathetic nerve fibers to
   the pupillary dilator muscle, the pupil remains persistently constricted to a smaller diameter than the pupil
   of the opposite eye.
2. The superior eyelid droops because it is normally maintained in an open position during waking hours, partly by contraction of smooth muscle fibers embedded in the superior eyelid and innervated by the sympathetics.
   Therefore, destruction of the sympathetic nerves makes
   it impossible to open the superior eyelid as widely as
   normally.
3. The blood vessels on the corresponding side of the face and head become persistently dilated.
4. Sweating (which requires sympathetic nerve signals)
   cannot occur on the side of the face and head affected
   by Horner syndrome.

Question 2

Pupila de Argyll Robertson

Answer 2

A pupil that fails to respond to light but does respond to accommodation and is also very small.
Is an important diagnostic sign of a central nervous system disease such as syphilis.

Question 3

Síndrome bulbar lateral (de Wallenberg)

Answer 3

Es secundario a oclusión de la arteria vertebral (más frecuente) o cerebelosa posteroinferior (PICA) (más característico). Clínicamente, se caracteriza por:
1. Síndrome vertiginoso con náuseas y vómitos por
afectación de los núcleos vestibulares.
2. Disartria y disfagia por paresia de la cuerda vocal,
faringe y velo del paladar ipsilateral, todo ello
secundario a lesión del núcleo ambiguo.
3. Diplopía, quizá secundaria a la extensión de la
lesión a la protuberancia inferior, donde se localiza
el VI par.
4. Hipoestesia facial ipsilateral por afectación del
núcleo espinal trigeminal en el bulbo lateral.
5. Hipoestesia corporal contralateral por afectación
del tracto espinotalámico.
6. Síndrome de Horner ipsilateral.
7. Ataxia cerebelosa ipsilateral secundaria a la afectación del pedúnculo cerebeloso inferior y cerebelo.