Horner’s syndrome is seen in all except –
Correct Answer: Medial medullary syndrome
Description: Ans. is 'b' i.e., Medial medullary syndrome Horner*s syndrome is a classic neurologic syndrome whose signs include : -Miosis,Ptosis, andAnhidrosisAlso called ocul sympathetic paresis, a Horner's syndrome can be produced by a lesion anywhere along the sympathetic pathway that supplies the head, eye, and neck.NeuroanatomyHorner's syndrome can result from a lesion anywhere along a three-neuron sympathetic (adrenergic) pathway that originates in the hypothalamusThe first-order neuronDescends caudally from the hypothalamus to the first synapse, which is located in the cervical spinal cord (levels C8-T2, also called ciliospinal center of Budge).The second-order neuronTravels from the sympathetic trunk, through the brachial plexus, over the lung apex. It then ascends to the superior cervical ganglion, located near the angle of the mandible and the bifurcation of the common carotid artery.The third-order neuronThen ascends within the adventitia of the internal carotid artery, through the cavernous sinus, where it is in close relation to the sixth cranial nerve.The ocul sympathetic pathway then joins the ophthalmic (VI) division of the fifth cranial nerve (trigeminal nerve).In the orbit and the eye, the ocul sympathetic fibers innervate the iris dilator muscle as well as Muller's muscle, a small smooth muscle in the eyelids responsible for a minor portion of the upper lid elevation and lower lid retraction.EtiologyThe etiology of Horner's syndrome in adults relates to the lesion location.First-order syndrome (central)* Lesions of the sympathetic tracts in the brainstem or cervicothoracic spinal cord can produce a first-order Horner's syndromeLateral medullary syndromeQ (M.C.)Brainstem disease (stroke, tumour, demyelinating disorder)SyringomyeliaCervical cord trauma (including surgery)Spinal cord tumourDiabetic autonomic neuropathyMultiple sclerosisSecond-order syndromeTrauma or surgery involving spinal cord, thoracic outlet lung apex.Pancoast tumourCarotid and Aortic aneurysm and dissectionLumbar epidural anaesthesia.Third-order syndrome (Postganglionic)Lesions of internal carotid artery such asDissection, thrombosisOtitis mediaCavernous sinus mass Surgery for Raynaud's syndrome (cervical sympathectomy) may cause trauma to cervical spinal cord.
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