Snapshot A 67-year-old man presents to his physician following a right-sided carotid endarterectomy. He reports mild pain at the surgical site but currently does not have any concerns. On physical exam, there is anisocoria with the right eye being miotic. There is also mild ptosis on the right eye as well. Introduction Clinical definition a neurologic syndrome characterized by ipsilateral miosis ptosis anhidrosis Pathogenesis can be caused by a lesion anywhere on the sympathetic pathway supplying the head, eyes, and neck review the sympathetic course in this illustration causes include Pancoast tumor Wallenberg syndrome syringomyelia and cervical cord trauma that affects the intermediolateral columns carotid endarterectomy and carotid artery stenting carotid dissection Presentation Symptoms and physical exam miosis resulting in anisocoria secondary to unchecked parasympathetic innervation ptosis due to impaired sympathetic innervation to Muller's muscle generally mild anhidrosis suggests an central or preganglionic lesion
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.NE.17.4766) A 65-year-old woman presents to her physician's office for a follow-up appointment for recently diagnosed bronchitis. The patient reports that her cough has not resolved and feels fatigued. Medical history is significant for hypertension and hyperlipidemia, which is currently being treated with hydrochlorothiazide and atorvastatin. She also has a 30 pack-year smoking history. Her temperature is 99°F (37.2°C), blood pressure is 140/90 mmHg, pulse is 105/min, respirations are 22/min, and oxygen saturation is 93% on room air. On physical exam, the patient's eyes are shown in Figure A. Cardiac and abdominal exam is unremarkable. This patient’s symptoms are most likely due to a pathological development that affects which of the following? QID: 109044 FIGURES: A Type & Select Correct Answer 1 Middle cervical ganglion 20% (42/211) 2 Superior vena cava 8% (16/211) 3 Stellate ganglion 35% (73/211) 4 Recurrent laryngeal nerve 3% (7/211) 5 Oculomotor nerve 27% (58/211) M 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic