Case 2 Answers

Basic Human Neuroanatomy

A Clinically Oriented Atlas

Case 2 Answers

1. Is there evidence of spinal cord involvement in this case and, if so, at what level?

2. Is there evidence of dorsal or ventral root involvement or spinal nerve involvement in this case, and, if so, what is the level(s) of the involvement?

3. Is there evidence of brachial plexus or peripheral nerve involvement in this case, and, if so, how would you differentiate between the two?

4. Is there evidence of autonomic nervous system involvement in this case? If so, what signs and symptoms support this conclusion?

Yes. Left ptosis and miosis. Left facial anhidrosis.

5. What is the localizing significance of the left-sided ptosis, miosis, and absence of sweating (anhidrosis), and what specific structures are involved by the pathologic process to produce these signs?

Since the left facial anhidrosis involves the entire face and head, the lesion must involve the sympathetic trunk and/or ganglia proximal to the superior cervical ganglion. Therefore, the lesion involves the preganglionic sympathetic fibers originating in the intermediolateral cell column (lateral horn) of the upper three thoracic spinal cord segments. Since no other CNS or PNS signs or symptoms are present, the pathological process is probably in the apex of the left lung and involves only the upper thoracic sympathetic trunk/ganglia.

6. This combination of signs and symptoms constitutes a classic neurologic syndrome. What is the name of that syndrome?

This combination of findings is known as a Horner’s syndrome.

7. In general, what type of pathologic process do you think is involved in this case?

Metastatic breast cancer to the apex of the left lung (Pancoast syndrome).

8. What diagnostic procedure(s) would you undertake at this point?

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