Neuro: Horner's Syndrome: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Horner’s Syndrome🎧 A clear, high-yield breakdown of this sympathetic nerve disorder affecting the eye and face – perfect for exam prep and clinical recognition.🧠 Key Learning Points📌 Definition• A rare neurological condition caused by disruption of the sympathetic nerves supplying the face and eye• Classic triad: ptosis, miosis, and anhidrosis on the same side of the face📌 Causes & Risk Factors• Central (1st-order neuron): stroke, MS, brainstem tumour• Preganglionic (2nd-order): Pancoast tumour, cervical rib, trauma, surgery• Postganglionic (3rd-order): carotid artery dissection, cluster headaches, herpes zoster, trauma• Congenital (with heterochromia iridis)💡 Mnemonic: PAM is Horny → Ptosis, Anhidrosis, Miosis📌 Pathophysiology• Disruption of the three-neuron sympathetic pathway from the hypothalamus → spinal cord (C8–T2) → cervical sympathetic chain → carotid artery → orbit• Loss of sympathetic input results in:– ↓ upper eyelid tone (ptosis)– Unopposed parasympathetic tone → constricted pupil (miosis)– Loss of facial sweating (anhidrosis)📌 Symptoms• Partial ptosis – drooping of upper eyelid• Miosis – small pupil, worsened in darkness• Anhidrosis – lack of sweating on the affected side• ± Apparent enophthalmos, heterochromia (if congenital)📌 Differential Diagnosis• 3rd nerve palsy – also has ptosis, but causes dilated pupil• Cluster headache – may mimic or cause Horner’s• Ophthalmoplegic migraine• Other causes of anisocoria or facial asymmetry📌 Diagnosis• Clinical exam: classic triad, anisocoria more obvious in dim light• Pharmacological tests:– Apraclonidine: reverses anisocoria (dilates Horner’s pupil)– Hydroxyamphetamine 1%: localises the lesion• Imaging depends on lesion location:– Central: MRI brain/spinal cord– Preganglionic: CXR, CT chest/neck– Postganglionic: Carotid Doppler, MRI/MRA head/neck/orbits, CTA💡 Use anatomy to guide investigations📌 Management• Treat the underlying cause– Tumour → surgery or oncology– Stroke → secondary prevention– Carotid dissection → urgent vascular referral ± anticoagulation• Symptomatic treatment rarely needed• Multidisciplinary referrals: neurology, vascular surgery, ENT, oncology as needed📌 Complications• Horner’s itself is not dangerous• Complications depend on cause: stroke, tumour growth, arterial rupture, etc.📌 Prognosis• Depends entirely on treatability of the underlying cause• Symptoms may resolve if cause is reversible; may persist otherwise• Congenital cases often lifelong but benign📎 More MSRA Resources for Horner’s Syndrome📝 Revision Notes: https://www.passthemsra.com/topic/horners-syndrome-revision-notes/🧠 Flashcards: https://www.passthemsra.com/topic/horners-syndrome-flashcards-2/💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/horners-syndrome-accordion-qa-notes-2/🚀 Rapid Quiz: https://www.passthemsra.com/topic/horners-syndrome-rapid-quiz-2/🧪 Quiz Bank: https://www.passthemsra.com/quizzes/horners-syndrome/🎓 Full Course: https://www.passthemsra.com/courses/neurology-for-the-msra/Hashtags#MSRA #MSRARevision #MSRATextbook #MSRAFlashcards #MSRAQANotes #MSRAQuiz #MSRAAccordions #MSRAQuestionBank #MultiSpecialityRecruitmentAssessment #MSRARevisionWebsite #Neurology #HornersSyndrome #Ptosis #Miosis #Anhidrosis #Apraclonidine #CarotidDissection