- descending fibre palsy
- lateral medullary syndrome (+ nystagmus)
- ipsilateral V pinprick, IX, X, XII palsy + contralateral pinprick on body
- eg Pancoast's tumour, trauma, other chest lesion
- ascending fibres
- carotid dissection, canvernous sinus lesion
This patient has features of a left Horner's syndrome – with anhydrosis, miosis and enophthalmposis with an ipsilateral lateral medullary syndrome, evidenced by left Vth nerve anaesthesia, left tongue and palate weakness with an absent gag. There is associated nystamus and cerebellar signs in the left upper limb and loss of pinprick sensation on the right.