Horner's Syndrome

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Horner's Syndrome

  • Disruption of sympathetic supply.
  • Pupil constricted - does not dilate in dark
  • Partial ptosis
  • Maybe loss of sweating - if lesion proximal to carotid plexus

Features

  • Meiosis
  • ptosis
  • enophthlamos
  • anhyhdrosis

Pathology

  • interruption of sympathetic supply to one half of face due to lesion in neck
  • course of sympathetic supply to pupil
    1. midbrain
    2. medulla
    3. T1 cord
    4. T1 root
    5. Thoracic ganglion
    6. Ascending preganglionic fibres
    7. superior cervical ganglion
    8. carotid plexus
    9. long ciliary nerve
    10. short ciliary nerve
    11. radial pupillodilator muscle / muscle of Müller

Examination

Face

  • General
    • ptosis
    • enopththalmos
    • hypohidrosis
  • Eyes
    • Acuity
      • normal
    • Fields 
      • normal
    • Pupils
      • small (miosis)
      • react to light and accommodation
    • Movements
      • nystagmus if brainstem disease
    • Fundi 
      • normal

Causes

  • Posterior inferior cerebellar artery or basilar artery occlusion
  • Multiple sclerosis
  • Hypothalamic lesions
  • Syringomelia in the pons
  • Cavernous sinus thrombosis
  • Cervical cord, mediastinal or Pancoasts tumour
  • Aortic aneurysm
  • Klumpke's paralysis
  • Cervical lymphadenopathy
 

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