Incidence of Horner syndrome associated with neuroblastic disease

Abstract

Purpose Horner syndrome (HS) manifests in unilateral ptosis, miosis, enophthalmos, and anhedonia. It is most commonly caused by trauma or surgical procedures, but can also occur in pediatric patients as a result of tumors, especially neuroblastoma (NBL). The objective of this study was to analyze the incidence of HS in patients diagnosed with NBL. Methods A retrospective analysis of data collected at the Department of Pediatric Oncology, Hematology, and Transplantology from 2004 to 2019 was performed. The study group included 119 patients younger than 18 years old, with 62 girls and 57 boys. All of them were diagnosed with a neuroblastic tumor. Results Among the 119 patients, eight children (6.72%) were diagnosed with HS associated with NBL. Three of these patients presented to the clinic with HS, whereas HS developed after the surgical procedure to remove the tumor in four patients. The adrenal gland was the most frequent localization of the tumor. However, HS occurred more frequently in patients with mediastinum tumors. As a presenting symptom, HS occurred in 2 of 11 cases (18.18%) with mediastinum localization. All of the patients with HS were younger than 2 years old. Conclusion Investigation of the cause of isolated HS is crucial because it can be the first symptom of NBL. However, the surgical procedure itself increases the risk of HS as a complication of NBL treatment.

Ophthalmologic Manifestations of Neuroblastoma: A Systemic Review

“…The incidence of ecchymosis, proptosis, Horner syndrome, and opsoclonus-myoclonus syndrome in pediatric patients with neuroblastoma 7,8,11,15,20. HS indicates Horner syndrome; OMS, opsoclonus-myoclonus syndrome.…”

“…In fact, HS represented 45.45% of the isolated ophthalmologic symptoms in patients suffering from NBL. It is an isolated manifestation in 1.14% of the NBL cases,7,11,20 whereas in 0.58% HS is congenital 8,11. Considering that HS may be a consequence of another pathology or idiopathy,85 the cases of congenital or isolated HS may be a challenge for the physicians in terms of the diagnostic decisions.…”

“…Moreover, patients with HS have a good prognosis with regard to the sight 15. According to the analyzed papers, HS is generally associated with the thoracic or cervical tumor localization (94.12% of cases vs. 5.88% adrenal tumors) 8,11…”

“…7,8,20 HS occurred in 4.44% of patients with NBL; 7,8,11 nevertheless, it was observed on presentation only in 2.09%. 7,8,11,15,20 It is worth emphasizing that HS may also constitute a complication following surgery, with the incidence equal to 1.55%. 7,8,11,15 In fact, HS represented 45.45% of the isolated ophthalmologic symptoms in patients suffering from NBL.…”

“…Furthermore, procedures, such as catheter insertion because of the NBL treatment, may also be associated with ophthalmologic disorders, primarily HS 101. In the previous research, we observed that the surgical treatment of the NBL resulted in ptosis and miosis more frequently than the disease itself 11. The incidence of tumor-caused HS differs considerably in various research studies because of the difficulties in planning such an analysis 10,102–105.…”