Horner Syndrome

Q: Horner Syndrome associated with Arm pain, hand weakness (typical of brachial plexus type lesions) suggest lesion at? 

 A) brainstem 
 B) cervicothoracic cord 
C) lung apex 
D) cavernous sinus 
E) internal carotid dissection


Answer: C

The classic triangle of Horner syndrome is

• ptosis
• miosis
• anhidrosis

Although in about 40 percent of cases no reason can be identified, it can be a manifestation of a serious underlying lesion/disease. Associated features help in locating the lesion site.

•  Brainstem lesion is marked by diplopia, vertigo, ataxia, and lateralized weakness
•  Lesion in cervicothoracic cord gives myelopathic features like bilateral or ipsilateral weakness, long tract signs, and bowel and bladder impairment 
•  Lesions in the apex of the lung is associated with arm pain and/or hand weakness typical of brachial plexus lesions 
•  Lesion in cavernous sinus gives Ipsilateral extraocular pareses, particularly a sixth nerve palsy, in the absence of other brainstem signs 
•  An isolated Horner syndrome accompanied by neck or head pain is probably due to internal carotid dissection

#physicalexam
#neurology

Reference:

Maloney WF, Younge BR, Moyer NJ. Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. Am J Ophthalmol 1980; 90:394.