A 58-year-old woman presents to the clinic with a 3-month history of right-sided neck pain and a drooping right eyelid. She also reports that she does not sweat on the right side of her face. Past medical history includes hypertension and hypothyroidism which are treated with lisinopril and levothyroxine. She has a 30-pack-year smoking history and does not drink alcohol. Vital signs are within normal limits. On physical examination, she has drooping of the right eyelid and contraction of the right pupil.
C) Horner syndrome
Horner syndrome results from disruption of the cervical sympathetic chain from injury, paralysis, or tumor and presents with unilateral ptosis, miosis, and anhidrosis. This patient's symptoms and smoking history raise concern for a possible underlying malignancy, such as a Pancoast tumor, which can invade the cervical sympathetic chain.
Answer choice A: Bell palsy, is incorrect. Bell palsy typically presents with unilateral facial paralysis affecting both the upper and lower face, but it does not cause miosis or anhidrosis.
Answer choice B: Cluster headache, is incorrect. Cluster headaches can cause unilateral autonomic symptoms, but they are typically associated with severe headache pain and do not cause ptosis and miosis without headache.
Answer choice D: Myasthenia gravis, is incorrect. Myasthenia gravis can cause ptosis and muscle weakness but does not cause miosis or anhidrosis.
Answer choice E: Third nerve palsy, is incorrect. Third nerve palsy can cause ptosis and pupil dilation (mydriasis) but does not cause miosis or anhidrosis.
Key Learning Point
Horner syndrome results from invasion of the cervical sympathetic chain and presents with unilateral ptosis, miosis, and anhidrosis.
