Table 1 Causes and clinical manifestations with respect to level of lesion for Horner’s syndrome (derived from multiple sources [1, 4, 5])
Level of the lesion | Possible cause | Additional clinical features |
|---|---|---|
Hypothalamus | Stroke, tumor, trauma | Contralateral hemiperesis, Contralateral hyperesthesia |
Thalamus | Stroke, tumor, trauma, demyelination | Contralateral ataxic hemiperesis, Contralateral hypoesthesia, vertical gaze paresis, dysphagia |
Dorsal mesencephalon | Stroke, tumor, trauma | Contralateral trochear nerve paresis |
Pons | Stroke, tumor, trauma | Ispilateral abducens nerve paresis (sometimes bilateral) |
Lateral medulla | Stroke, tumor, trauma | Ipsilateral ataxia. contralateral hyperalgesia, vertigo, dysphagia, nystagmus, facial nerve paresis |
Spinal cord | Infarction, tumor, trauma, demyelination, myelitis, syringomyelia, arterioveneous malformation | Ipsilateral or contralateral sensory dissociation, systemic dysautonomia |
Apical lung | Pancoast tumor, schwaanoma, subclavian artery aneurysm, mediastinal tumor, cervical rib, trauma | Ipsilateral shoulder pain, paresthesias along the upper limb, Atrophy of small muscles of the hand |
Internal carotid artery | Tumor, trauma, aneurysm, dissection, arteritis, thrombosis | Incomplete HS (absence of anhidrosis) |
Skull base | Nasopharyngeal carcinoma, lymphoma, trauma | Incomplete HS, ‘lump in neck’, bloody rhinorrhoea, hearing loss |
Cavernous sinus | Tumor, trauma, inflammation, thrombosis | Incomplete HS, headache, eye pain, diplopia |