Ptosis and Horner syndrome

Published on 02/04/2015 by admin

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Last modified 02/04/2015

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38 Ptosis and Horner syndrome

Instruction

Examine this patient’s face.

Salient features

History

• Ask the patient whether or not there is absence of sweating on one side of the face

• History of lung cancer

• History of cervical sympathectomy

• Migraine.

Examination

In the examination if you notice ptosis then you must answer the following questions:

• Is ptosis complete or incomplete?

• Is it unilateral or bilateral?

• Is the pupil constricted (Horner syndrome) or dilated (third nerve palsy)?

• Are extraocular movements involved (third nerve palsy or myasthenia gravis)?

• Is the eyeball sunken or not (enophthalmos)?

• Is the light reflex intact (intact light reflex in Horner syndrome)?

If the patient has Horner syndrome, then quickly proceed as follows:

• Examine the supraclavicular area:

• Percuss the supraclavicular area, looking for dullness of Pancoast’s tumour
• Look for scar of cervical sympathectomy (be prepared with indications for cervical sympathectomy)
• Look for enlarged lymph nodes.

• Examine the neck:

• for carotid and aortic aneurysms
• for tracheal deviation (Pancoast’s tumour).

• Examine the hands:

• for small muscle wasting
• for pain sensation with a pin
• for clubbing.

These should help in making a diagnosis of syringomyelia or Pancoast’s tumour.

If there is no clue so far about the cause, tell the examiner that you would like to examine for nystagmus, cerebellar signs, cranial nerves and pale optic discs, and pyramidal signs to ascertain brainstem vascular disease or demyelination.

Diagnosis

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