Droopy eyeBMJ 2006; 332 doi: https://doi.org/10.1136/sbmj.0605194 (Published 01 May 2006) Cite this as: BMJ 2006;332:0605194
- Akheel A Syed, specialist registrar1,
- R Deeba Syeda, preregistration house officer2,
- Farheena N Mecci, clinical tutor3
- 1South Tyneside District Hospital, South Shields NE32 0PL
- 2Sri Devraj Urs Medical College, Kolar, India (on sabbatical in the UK)
- 3Dr Ambedkar Medical College, Bangalore, India (on sabbatical in the UK)
A woman aged 83 presented with increasing shortness of breath of a few weeks' duration. Air entry was reduced and percussion on the right side of her chest produced a dull note. The skin on the right side of her face was dry, in addition to the features seen in the photograph (fig 1).
Fig 1 Note the drooping of the upper eyelid and the smaller pupil on the right; the right side of her face was also dry to the touch.
What neurological diagnosis is suggested by the findings in her face?
What investigation will you perform next? What is the underlying diagnosis?
She had right sided ptosis, miosis, and anhidrosis, features that characterise an oculosympathetic palsy known as Horner's syndrome.
A postero-anterior chest x ray was performed (fig 2, panel A). This showed opacification of the right upper zone with pleural effusion of a moderate volume; a computed tomography scan confirmed a primary bronchogenic carcinoma in the posterior part of the right upper lobe and right sided pleural effusion (fig 2, panel B), …