Ophthalmological conditions - Horner syndrome
Description
- Interruption of the oculosympathetic pathway -> ptosis + miosis +/- anhidrosis on the affected side
- *Horner syndrome is a localising sign, not a diagnosis. The task is always to find the lesion*
The three-neurone pathway
| Order | From -> to | Runs through |
|---|---|---|
| 1st (central) | Posterolateral hypothalamus -> ciliospinal centre of Budge | Brainstem, lateral medulla, cervical cord |
| 2nd (pre-ganglionic) | Ciliospinal centre of Budge (C8-T2) -> superior cervical ganglion | Ventral roots, over the lung apex, brachial plexus, thoracic outlet, along the subclavian |
| 3rd (post-ganglionic) | Superior cervical ganglion -> orbit | Along the internal carotid artery, cavernous sinus, with CN V1 (nasociliary) -> long ciliary nerves |
- Sudomotor fibres to the face follow the EXTERNAL carotid and leave at the bifurcation
- -> anhidrosis occurs with central and pre-ganglionic lesions, NOT post-ganglionic
- A post-ganglionic lesion may cause anhidrosis of a small medial forehead patch only
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