SPOTTERS MEDICINE
HORNER’S SYNDROME – BRIEF NOTES
🔹 Definition:
Horner’s
syndrome is a neurological disorder caused by disruption of the sympathetic
pathway to the face and eye, characterized by ptosis, miosis,
anhidrosis, and enophthalmos.
🔹 Classic Triad:
1.
Ptosis –
drooping of upper eyelid (due to paralysis of Müller’s muscle)
2.
Miosis –
constricted pupil (loss of sympathetic dilation)
3.
Anhidrosis –
decreased sweating on affected side of face
🔸 Sometimes includes enophthalmos
(sunken eyeball)
🔹 Sympathetic Pathway Anatomy (3
Neuron Arc):
1.
First-order neuron (central):
o Hypothalamus → brainstem → spinal
cord (C8–T2, ciliospinal center of Budge)
o Lesions: stroke, tumor, syringomyelia
2.
Second-order neuron (preganglionic):
o Spinal cord → apex of lung → superior
cervical ganglion
o Lesions: Pancoast tumor, neck trauma,
thoracic surgery
3.
Third-order neuron (postganglionic):
o Superior cervical ganglion → carotid
artery → eye and face
o Lesions: carotid artery dissection,
cluster headache
🔹 Causes:
- Central causes: Brainstem stroke, MS, trauma
- Preganglionic: Pancoast tumor, thyroid or neck
surgery, cervical rib
- Postganglionic: Carotid artery dissection,
cavernous sinus thrombosis, cluster headache
🔹 Clinical Features:
- Unilateral ptosis (mild)
- Miosis (small pupil unresponsive to
light)
- Anhidrosis (hemifacial or forehead)
- Enophthalmos (less common)
- Loss of ciliospinal reflex
🔹 Diagnosis:
- Clinical examination
- Pharmacological testing:
- Cocaine test (no dilation of
pupil)
- Apraclonidine test (reversal of
anisocoria – diagnostic)
- Imaging: MRI/CT of brain,
neck, and chest (to find cause)
🔹 Differential Diagnosis:
- Third nerve palsy (dilated pupil
+ ptosis)
- Physiological anisocoria
- Cluster headache (may mimic)
🔹 Treatment:
- No direct treatment for Horner’s syndrome
- Management depends on underlying
cause
- Pancoast tumor →
surgery/radiation
- Carotid dissection →
anticoagulation
- Stroke → supportive and
rehabilitative care
🔹 Prognosis:
- Depends on cause and location
of lesion
- Isolated Horner’s may be benign
- Needs prompt investigation to rule
out life-threatening causes
DR.C.GANESAN M.D.
PROFESSOR OF MEDICINE
No comments:
Post a Comment