Horners Syndrome

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Definition

-  Ipsilateral ptosis, miosis & anhidrosis caused by SNS disruption to the eye +/- face

 

Features

-   

 

Causes

-  1st order neurons (CNS C8-T1)

-  Stroke: Wallenburg syndrome

-  MS

-  Tumour: pituitary, basal skull

-  Basal meningitis

-  Cervical spine injury

-  2nd order neurons (Cervical SNS Chain)

-  Pancoasts tumour or lymphadenopathy

-  Cervical rib

-  Aneurysm/dissection of aorta

-  Birth trauma (shoulder dystocia): lower brachial plexus

-  Neuroblastoma

-  3rd order neurons (Post ganglionic)

-  Internal carotid artery dissection

-  Cluster Headache

-  Herpes zoster

-  Drugs

 

Associated S/S

-  Symptoms ipsilateral to lesions unless lesions bilaterally

-  All pts

-  Ptosis: mild to moderate

-  Miosis

-  Dilation lag (? Afferent papillary defect)

-  1st order neurons

-  Hemisensory loss, dysarthria, dysphagia, ataxia, vertigo, nystagmus, +/- anhidrosis

- 2nd order neurons

-  Trauma, Sx, procedures to neck or chest

-  Erbs palsy

-  Cough, haemoptysis, anhidrosis

-  3rd order neurons

-  Diplopia (CNIV palsy), trigeminal numbness, pain, anhidrosis

-  Painful: ? internal carotid artery dissection

-  Iris heterochromia (effected iris is hypopigmented)

-  Congenital Horners syndrome

-  Long standing Horners syndrome

 

 

Hx & Ex

-  Extraocular movements

-  Visual field testing

-  Facial sensation

-  Vesicles, fever, malaise: Herpes zoster

 

Ix

-  +/- MRI/MRA

-  CXR/Chest CT+/-

-  Pharmacologic testing

-  Cocaine 4% or 10%

-  Bilaterally

-  Should dilate both eyes (SNS)

-  Wait 40-60 min

-  Aniscoria  > 0.8mm = Dx

-  Apraclonidine 0.5% or 1%

-  As alt to cocaine

 

Mx

-  Underlying cause