Medical Sciences (Anatomy, Physiology, Pharmacology etc.)

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Horner’s Syndrome

Horner’s syndrome is acquired through damage to the sympathetic nerve supply and could cause partial ptosis, miosis, or facial anhidrosis. In this case, the patient demonstrated extreme pupil constriction and reduced sweating on the affected side. The syndrome was first discovered and described in 1727 by Francois Pourfour du Petit and further developed in 1852 by Claude Bernard; it was then named by Swiss ophthalmologist Johann Friedrich Horner in 1869 (Khan 2020).

Acetylcholine is present at all autonomic nervous system preganglionic fibers, including the sympathetic nervous system. The patient demonstrated extreme pupil constriction and reduced sweating, suggesting blockage of the transmission in the sympathetic nervous system. When the young resident who diagnosed with the condition injected acetylcholine, it induces sweating, but not no change is observed in the pupil size. The result was because the sweat glands are exempted from a normal transmission in the sympathetic nervous system while at the same time, the postganglionic fibers use acetylcholine as a neurotransmitter. Other sympathetic nervous system pathways use norepinephrine as their neurotransmitter. Therefore acetylcholine, while acting directly on the sweat gland to initiate sweating, failed to stimulate the typical postsynaptic neurons to release norepinephrine. From the doctor’s next step, where he injects norepinephrine, pupil dilation was achieved but not sweating, suggesting that norepinephrine worked directly at the iris to achieve pupil dilation. From the two injections, the problem can be traced to the postsynaptic neuron by a method of elimination because if the problem had been with the presynaptic neuron, injecting acetylcholine would have solved both the extreme pupil constriction and the reduced sweating.

 

 

Works Cited

Khan Z, Bollu PC. Horner Syndrome. [Updated 2020 May 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Retrieved on 27th November from https://www.ncbi.nlm.nih.gov/books/NBK500000/

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