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Right Preganglionic Horner Syndrome Dfagmn Akjdg Amg 'Lakg'lakg'lakg'alkg'akg'ag'akg Akg A Kgakg'agka
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sweating on the ipsilateral face and neck make up the complete syndrome.
Sweating on the face is normal in postganglionic lesions because postganglionic
fibers to the face for sweating follow the external rather than the internal carotid
artery.
Central Horner's syndrome may be due to brainstem infarction, particularly lateral
medullary infarction (Wallenberg's syndrome), syringomyelia, or cervical cord
tumor. Preganglionic Horner's syndrome may be due to cervical rib, cervical
vertebral fractures, apical pulmonary lesionsparticularly bronchogenic
carcinoma (Pancoast's syndrome)or brachial plexus injuries. Postganglionic
Horner's syndrome may be due to carotid artery dissection, skull base tumors, or
cluster headache. The localization of central and preganglionic Horner's syndrome
is often apparent from the associated clinical features. Sudden-onset isolated
painful Horner's syndrome, particularly with a recent history of neck trauma or
associated with pain in the neck or jaw, necessitates urgent investigation for
carotid dissection, which may lead to thrombotic or embolic stroke. Horner's
syndrome associated with chronic facial pain, particularly if associated with fifth,
sixth, third, fourth, or second cranial nerve palsy, requires investigation for skullbase tumor.
Pharmacologic testing with topical cocaine in the conjunctival sac differentiates
Horner's syndrome, in which the pupil does not dilate, from physiologic
anisocoria. Topical apraclonidine, which causes dilation of the affected but not the
normal pupil, can also be used. Testing with hydroxyamphetamine drops
differentiates central and preganglionic from postganglionic lesions, but they are
difficult to obtain.