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Ptosis

Ptosis  is a very interesting problem that can be due to multiple causes. Two forms of ptosis deserve special attention.
One is Ptosis associated with miosis and the second one is ptosios associated with mydriasis. The former is due to Horner's syndrome (affects the sympathetic pathway) and the second (with mydriasis) which is due to parasympathetic loss with 3rd nerve palsy.

The sympathetic path is thoracolumbar and the parasympathetic is craniosacral. If a has a lesion in the sympathetic system, it could be anywhere between the brain and the first cervical ganglion. Typically Horner,s syndrome will be presented with a patient with a pancoast,s syndrome and one will either be shown a CXR or asked what investigation should be next if a CXR is not shown. Remember that the peripheral lesions are mainly Adenocarcinomas. Alveolar cell Ca too is peripheral.