Horner’s syndrome

From WikiCNS

1. Interruption of the sympathetic fibers at any point along the internal carotid arteries or removal of the superior cervical ganglion results in a Horner’s syndrome
   1. ptosis – due to interruption of sympathetic innervation of levator palpebrae superioris
   2. miosis – due to interruption of sympathetics to pupil
   3. anhydrosis – loss of sympathetics to one side of the face
2. Horner’s syndrome may also be caused by interruption of the preganglionic fibers at any point between their origin in the intermediolateral cell column of C8-T2 spinal segments and the superior cervical ganglion or by interruption of the descending, uncrossed hypothalmospinal pathway in the tegmentum of the brainstem or cervical cord
   1. the ciliospinal center of Budge is found in the lateral horn at T1 and T2; it is a sympathetic nucleus that innervates the iris
3. Common causes: inflammation of cervical lymph nodes or surgical trauma to those structures, carotid artery dissection, syringomyelia or trauma to the first or second thoracic spinal segments, infarcts or lesions of the lateral medulla (a.k.a. Wallenberg which is the most common)
4. Lesion of the stellate ganglion (just adjacent to body of T1) produces a Horner’s syndrome and paralysis of sympathetic reflexes in the arm (hand and arm are warm and dry)
   1. with preganglionic lesions, facial flushing may develop on the side of the sympathetic disorder
5. Congenital Horner’s syndrome may be inherited as an autosomal dominant trait and is characterized by failure of one eye to develop normal iris color

From Greenberg MS, Handbook of Neurosurgery 6th ed. Thieme: 2006:

1. Miosis

2. Ptosis

3. Enophthalmos

4. Hyperemia of the eye

5. Anhidrosis of 1/2 face