Horner s syndrome anatomy and physiology

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Horner s syndrome anatomy and physiology

Introduction The human internal environment is regulated in large measure by the integrated activity of the autonomic nervous system and endocrine glands.

Their visceral and homeostatic functions, essential to life and survival, are involuntary. Why the forces of evolution favored this separation from volition is an interesting question.

However, many general neurologic diseases involve the autonomic nervous system to a varying extent, giving rise to symptoms such as syncope, sphincteric dysfunction, pupillary abnormalities, erectile dysfunction, diaphoresis, cardiac dysrhythmias, and disorders of thermoregulation.

Finally, in addition to their central role in visceral innervation, autonomic parts of the neuraxis and parts of the endocrine system are engaged in all emotional experience and its display, as discussed in Chap. Breathing is unusual among nervous system functions.

Although continuous throughout life, it is not altogether automatic, being partly under volitional control. Current views of the central and peripheral control of breathing, and the ways in which it is altered by certain diseases are of considerable interest to neurologists, if for no other reason than respiratory failure is common in neurologic conditions such as coma, cervical spinal cord injury, and a large number of acute and chronic neuromuscular diseases.

Many of these same comments pertain to the function of swallowing, which is largely automatic and continues at regular intervals even in sleep but is also initiated voluntarily.

Furthermore, swallowing fails in ways similar to breathing as a consequence of neurologic diseases. The autonomic, endocrine, and respiratory systems, although closely related, give rise to disparate clinical syndromes.

This chapter deals more strictly with the autonomic nervous system and the neural mechanisms of respiration and swallowing, and the next chapter, with the hypothalamus and neuroendocrine disorders.

The following discussion of anatomy and physiology serves as an introduction to both chapters. Anatomic Considerations The most remarkable feature of the autonomic nervous system is that a major part of it is located outside the brain and spinal cord, in proximity to the visceral structures that it innervates.

This position alone seems to symbolize its relative independence from the cerebrospinal system. In distinction to the somatic neuromuscular system, where a single motor neuron bridges the gap between the central nervous system CNS and the effector organ, in the autonomic nervous system there are always two efferent neurons serving this function, one preganglionic arising from its nucleus in the brainstem or spinal cord and the other postganglionic arising from specialized nerve cells in peripheral ganglia.

Figure illustrates this fundamental anatomic feature. Sympathetic outflow from the spinal cord and the course and distribution of sympathetic fibers. The preganglionic fibers are in heavy lines; postganglionic fibers are in thin lines.

The autonomic nervous system, from an anatomic point of view, is divided into two parts: The systems differ architecturally in that the ganglion in the sympathetic nervous system is located in a contiguous and interconnected, longitudinal chain sympathetic chain paravertebrally, whereas the parasympathetic ganglia are distributed in proximity to the structures they innervate.

Moreover, the main neurotransmitter of the postganglionic connection to the end organ is norepinephrine in the case of the sympathetic nerves and acetylcholine for parasympathetic innervation. There are exceptions with regard to the sympathetic innervation of sweat glands sudomotorwhich are cholinergic.

The neurotransmitter between the pre- and postneurons throughout the autonomic nervous system, sympathetic and parasympathetic, is acetylcholine as reiterated further on.

These synapses between pre- and postganglionic cholinergic nerves are not blocked by atropine nicotinic whereas the postganglionic impulses are blocked by atropine muscarinic. The parasympathetic craniosacral division of the autonomic nervous system. Preganglionic fibers extend from nuclei of the brainstem and sacral segments of the spinal cord to peripheral ganglia.

Horner s syndrome anatomy and physiology

Short postganglionic fibers extend from the ganglia to the effector organs. The lateral-posterior hypothalamus is part of the supranuclear mechanism for the regulation of parasympathetic activities. The frontal and limbic parts of the supranuclear regulatory apparatus are not indicated in the diagram see text.

The Human Nervous System, 3rd ed. New York, McGraw-Hill, The sympathetic thoracolumbar division of the autonomic nervous system. Preganglionic fibers extend from the intermediolateral nucleus of the spinal cord to the peripheral autonomic ganglia, and postganglionic fibers extend from the peripheral ganglia to the effector organs, according to the scheme in Fig.

Functionally, the two parts are complementary in maintaining a balance in the tonic activities of many visceral structures and organs. This rigid separation into sympathetic and parasympathetic parts, although useful for purposes of exposition, is physiologically not absolute.

Nonetheless, the notion of a balanced sympathetic and parasympathetic autonomic system has stood the test of time and remains a valid concept. The cranial division originates in the visceral nuclei of the midbrain, pons, and medulla. These nuclei include the Edinger-Westphal pupillary nucleus, superior and inferior salivatory nuclei, dorsal motor nucleus of the vagus, and adjacent reticular nuclei.

Axons preganglionic fibers of the visceral cranial nuclei course through the oculomotor, facial, glossopharyngeal, and vagus cranial nerves. The preganglionic fibers from the Edinger-Westphal nucleus traverse the oculomotor nerve and synapse in the ciliary ganglion in the orbit; axons of the ciliary ganglion cells innervate the ciliary muscle and pupillary sphincter see Fig.

The preganglionic fibers of the superior salivatory nucleus enter the facial nerve and, at a point near the geniculate ganglion, form the greater superficial petrosal nerve, through which they reach the sphenopalatine ganglion; postganglionic fibers from the cells of this ganglion innervate the lacrimal gland see also Figs.

Other fibers originating in the salivatory nuclei are carried in the facial nerve and traverse the tympanic cavity as the chorda tympani to eventually join the submandibular ganglion. Cells of this ganglion innervate the submandibular and sublingual glands.Introduction.

Obstructive sleep apnoea (OSA) is an increasingly common disorder characterised by repetitive narrowing and collapse of the pharyngeal airway during sleep,.This results in a substantial decrease (hypopnoea) or complete cessation (apnoea) of airflow despite increased effort to breathe.

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The key to . Horner’s syndrome is merely the collection of clinical signs associated with lesions anywhere in this sympathetic nerve supply to the head, and a brief review of the relevant anatomy is appropriate.

Horner’s Syndrome Anatomy and physiology Horner’s syndrome is a rare condition that targets the nerves in one’s eyes and face.

Horner’s syndrome is caused by any type of interruption in a pack of nerves that begin in a part of one’s brain that is called the hypothalamus and it travels to one’s face to their eyes.

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Horner s syndrome anatomy and physiology

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