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The spinal cord nuclei in which sympathetic impulses originate are present only from the T2 level downward. Thus, the sympathetic fibers innervating the head must ascend from the thoracic spinal cord and the thoracic segments of the sympathetic chain, by way of the interganglionic branches, to the cervical sympathetic chain, where they make a synaptic relay onto the second neuron in one of the three cervical ganglia (in- cluding the stellate ganglion). From these ganglia, the sympathetic fibers continue upward in periarterial nerve plexuses until they reach their destinations. Sympathetic fibers in the head innervate the walls of the blood vessels, the sweat glands, and the salivary, lacrimal, nasal, and palatal glands, as well as the smooth muscle of the dilator pupillae m. Lesions of the cervical sympathetic pathway. Destruction of the stellate ganglion or of the cervical sympathetic chain causes Horner syndrome: the pupil is (unilaterally) narrow and, when the patient looks slightly downward, ptosis is evident Horner syndrome is usually seen in conjunction with loss of sweating on the ipsilateral upper quadrant of the body, particularly on the neck and face. Depending on the level of the lesion, the arm, hand, and axilla may be affected as well. If the sympathetic chain is interrupted immediately below the stellate ganglion, anhidrosis of the upper quadrant of the body results, but without Horner syndrome. On the other hand, isolated Horner syndrome without anhidrosis can occur as the result of a lesion of the C8−T2 nerve roots between the spinal cord and the sympathetic chain.