Horner syndrome

Background

Scheme showing sympathetic and parasympathetic innervation of the pupil and sites of a lesion in Horner's syndrome.

• Involves lesion anywhere along the sympathetic tract:
  • Central (Hypothalamus, brainstem, spinal cord)
  • Preganglionic (Pulmonary apex)
  • Postganglionic (Superior cervical ganglion, ICA, skull base, cavernous sinus)

Causes

• Adults
  • CVA
  • Brain tumor, lung mass
  • ICA dissection
  • Zoster
  • Trauma
• Peds
  • Neuroblastoma
  • Lymphoma
  • Mets

Clinical Features

Left-sided Horner's syndrome

• Ipsilateral ptosis, miosis, anhidrosis
• Neck pain suggest carotid artery dissection

Evaluation

• CXR
• CT brain
• CT Angiography head and neck, MRI, or MRA if concern for carotid artery dissection