Horner syndrome

Horner syndrome
confirm it is horner
"Everything is small"-ptosis,small pupil(miosis),anhydrosis and enolthalmos(occasionally)

proceed to horner protocol
check other cranial nerve to rule out Wallenberg(lateral medullary) syndrome, sensation 5th, facial nerve, gag reflex for 9th and 10th and cerebellar sign plus contralateral sensation .

If no, then look for radiation marking , wasting small muscle , dullness apical ocasionally engorged vessel (Superior vena cava obs) to suggest Pancoast tumour.

dissociated sensory loss and burn scar to suggest syringomyelia if gag reflex reduced than syringobulbia.

surgical scar at neck may suggeast injury to the T1 nerve.

Present the finding .
You should be safe for this station.
(P/S) may sure it is Horner before do all this.

Approach patient with unilateral ptosis

When You see patient with partial ptosis, One of the commonest patient found in neuro station. See whether it is unilateral or bilateral.
for unilateral
The second thing to do is look directly to pupil size,
If pupil size is small then you should enter Horner syndrome protocol which i will explain in my next explaination.
If pupil size is big then , it is third nerve palsy(a surgical third nerve palsy) most likely posterior communicating artery aneurysm.
If pupil size is normal then most likely (medical third nerve palsy) most likely diabetic or vasculitis cause and etc.
Third please demonstate the eye movement to see whether got other nerve involvement.etc 4th or 5th
If got 3rd ,4th and 5th, consider Graves disease(lid retraction )
cavernous sinus 3th 4th 6th and 5th may coexixst(demonstrate corneal reflex)
tolosa hunt (pain with no redness)