Horner’s syndrome

Horner’s syndrome

Pathology:                  Miosis,ptosis and anhydrosis caused by lesions in the oculosympathetic pathway


Aetiology:                    Central: Lesions involvinghypothalamus, brain stem and cervical cord such as

                                                             infarct, bleed and demyelination

Preganglionic: Cervicothoracic cordtrauma, tumors or syrinx, lower brachial

                                                                           plexus injuries, apical lung tumors, cervicalrib

Postganglionic: Migraine, clusterheadache, internal carotid artery dissection,

     cavernous sinus pathologies


Symptoms:                 Usually mild and can go unnoticed by patient


Signs:                            Miosis, ptosis andanhydrosis on one side of the face


Investigations:          Special tests: Apraclonidine test (topicalalpha agonist which constricts normal eye

and reverses Horner’s eye) help confirm the diagnosis

Imaging: Chest X-ray: to identify apical tumour

                   MRI/CT: to assess tounderlying pathology


Treatment:                  Conservative: Symptoms of Horner’ssyndrome are usually mild and do not require

 any intervention.

Surgical: Correction of ptosis couldbe considered in some cases.


Complications:          Dependent on underlying cause


Prognosis:                   Dependent on underlyingcause

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