Abstract
Horner's Syndrome results from a disturbance in the sympathetic pathway containing three neurons. The first neuron begins in the hypothalamus and descends to synapse in the lower cervical and upper thoracic spinal cord. The second neuron, whose cell body is located within the spinal cord, ascends to synapse in the superior cervical ganglion in the region of the mandibular angle. The third neuron, with its body in the superior cervical ganglion ascends with the carotid artery into the cavernous sinus and then goes through the superior orbital fissure to innervate the dilator muscle of the iris via the long ciliary nerves. Patients with Horner's syndrome may present due to blepharoptosis or miosis, and more rarely anhidrosis or simply as a coincidental finding during an examination. The causes of Horner's syndrome vary depending on the neuron involved. Diagnosis may be verified via pharmacological testing with topical cocaine or apraclonidine. When localization is not obvious, the entire sympathetic pathway should be imaged with the options of MRI, CT, CTA and MRA. There is no cure for Horner's syndrome and management primarily focuses on treating the underlying cause.
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