<prompt> Horners syndrome is caused by: March 2009Facial injuryNasopharyngeal carcinoma with metastasisMenieres diseaseAll of the above  <response>: Ans. B: Nasopharyngeal carcinoma with metastasis Causes of Homers syndrome: First-order neuron lesions - Arnold-Chiari malformation - Basal meningitis e.g., syphilis - Basal skull tumors - Cerebral vascular accident CVA Wallenberg syndrome lateral medullary syndrome disease e.g., multiple sclerosis - Intrapontine hemorrhage Neck trauma e.g., traumatic dislocation of cervical veebrae, traumatic dissection of the veebral aery - Pituitary tumor - Syringomyelia Second-order neuron lesions - Pancoast tumor tumor in the apex of the lung - most commonly squamous cell carcinoma - Bih trauma with injury to lower brachial plexus - Cervical rib Aneurysmdissection of aoa - Nasopharyngeal carcinoma involvement of cervical sympathetic chain - Central venous catheterization Traumasurgical injury e.g., radical neck dissection, thyroidectomy, carotid angiography, coronary aery bypass graft - Lymphadenopathy e.g., Hodgkin disease, leukemia, tuberculosis, mediastinal tumors - Neuroblastoma Third-order neuron lesions - Internal carotid aery dissection associated with sudden ipsilateral face andor neck pain - Raeder syndrome paratrigeminal syndrome - Oculosympathetic paresis and ipsilateral facial pain with variable involvement of the trigeminal and oculomotor nerves - Carotid cavernous fistula Cluster migraine headaches - Herpes zoster Drugs may cause symptoms similar to Horner syndrome and may affect any region - Acetophenazine - Bupivacaine - Chloroprocaine - Chlorpromazine 