Aetiology
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Associated clinical findings:
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Cluster headache |
- Transient Horners; comes and goes
- Severe headache, with rhinorrhoea and excessive tear production
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Cortical stroke (hemispheric) |
- weakness, sensory deficit, homonymous hemianopia, diplopia, or ataxia
- No sensory or motor level (instead, hemiplegia)
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Brainstem stroke (lateral medullary syndrome) |
- Contralateral pain and temperature sensory loss
- Ipsilateral facial sensory loss
- Ipsilateral nystagmus
- Dysphagia
- Ipsilateral V, IX and X cranial nerve lesions
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Cavernous sinus pathology |
- An associated sixth nerve palsy
- Everything in the cavernous sinus may have been taken out (that being upper facial branches of the 5th nerve, the 4th nerve and the 3rd nerve)
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Syringobulbia |
- Dysphagia
- Nystagmus
- Pharyngeal and palatal weakness
- Asymmetric weakness and atrophy of the tongue
- Sensory loss involving primarily pain and temperature senses in the distribution of the trigeminal nerve
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Syringomyelia |
- Bilateral signs!
- Dissociated sensory loss: lost pain and temperature sensation, but preserved light touch, vibration and proprioception
- Cape-like distribution of pain
- Hand weakness
- Bowel and bladder incontinence, sexual dysfunction
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Spinal injury or infarction |
- Weakness, sensory deficit; with a distinct sensory or motor level
- No diplopia or hemianopia
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Malignancy in the apex of the lung |
- Wasting of small muscles of hand and clubbing
- Cervical and axillary lymph nodes
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Thyroid cancer |
- Suprasternal mass, goitre
- Thyroid bruit
- Cervical and supra/infraclavicular lymph nodes
- Signs of retrosternal goitre, eg. stridor
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Neck trauma or surgery |
- Various scars, signs of head / neck surgery/trauma (it wouldn't be subtle)
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Lower trunk brachial plexus injuries |
- Motor deficit isolated to the affected arm
- Weakness in all median and ulnar innervated hand muscles
- Weakness in radial innervated distal forearm and wrist muscles.
- Sensory loss in the medial aspect of the arm, forearm and hand
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Carotid aneurysm or dissection |
- Sudden onset of the syndrome
- Pain of the neck or face
- A carotid bruit which is unilateral
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