Neuroimaging experience in pediatric Horner syndrome

Kadom, Nadja; Rosman, N. Paul; Jubouri, Shams; Trofimova, Anna; Egloff, Alexia; Zein, Wadih M.

doi:10.1007/s00247-015-3341-9

Cited by 19 publications

(13 citation statements)

References 30 publications

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“…Most papers recommend a physical examination which is not well defined. Controversy exists with regard to requirements for either (i) urinary catecholamines analysis and (ii) imaging studies (chest radiograph, ultrasound, CT scan, MRI) 2 14…”

Section: Discussionmentioning

confidence: 99%

Paediatric Horner’s syndrome: is investigation for underlying malignancy always required?

Braungart

Craigie²,

Farrelly

et al. 2019

Arch Dis Child

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ObjectiveHorner’s syndrome (HS) is characterised by a triad of ocular miosis, ptosis and anhidrosis. HS may be a subtle sign of occult pathology in otherwise asymptomatic children, neuroblastoma (NBL) being the the most common associated malignant tumour. Despite such knowledge, the incidence of underlying malignancy in children with HS remains unclear and robust evidence to guide best clinical practice is sparse. We performed a systematic review of the literature with the aim of identifying the incidence of NBL in children with HS of unknown aetiology, and establishing if screening for NBL should be routinely performed in this patient population.MethodsSystematic review of the literature (PubMed and Ovid/Medline database, 1961–2018).ResultsThe initial search identified 334 manuscripts, of which 8 studies were included in the final analysis. All reports were single-centre retrospective studies without control groups and included a total of 152 patients (age range 0–20 years). All studies investigated patients with HS but without previously established diagnosis. In the studies included, 17 out of a total of 152 patients were diagnosed with a space-occupying lesion. 12 out of the 152 patients were subsequently detected with NBL.ConclusionHS in children may be the first sign of occult malignancy. We report the first systematic review that comprehensively investigates the incidence of malignancy in this unique patient cohort. We show that HS of unknown aetiology in children warrants further investigation(s) to exclude an underlying space-occupying lesion. This should include cross-sectional imaging of the brain, neck and thorax, plus urinary catecholamines for prompt diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Paediatric Horner’s syndrome: is investigation for underlying malignancy always required?

Braungart

Craigie²,

Farrelly

et al. 2019

Arch Dis Child

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“…Rarely, the congenital Horner syndrome may be of autosomal dominant inheritance. [3][4][5] An acquired Horner syndrome in children can be of neoplastic or nonneoplastic etiology. The most common childhood tumor causing the acquired Horner syndrome is neuroblastoma, 1 with an incidence, risk estimated around 1 per 10 cases.…”

Section: Discussion Etiologymentioning

confidence: 99%

“…If we take in consideration the other mass lesions including paraganglioma, ganglioneuroma, childhood thyroid cancer, schwannoma, rhabdoid tumor, astrocytoma of the hypothalamus, leukemia, and reactional lymphadenopathy, this risk increase at 1/7. [3][4][5][6][7] Vascular etiology is the most common cause in adult, but also manifest in children, and not just among teenagers as seen in case 2. It implicates arterial dissection 8 and aneurysm.…”

Section: Discussion Etiologymentioning

confidence: 99%

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Horner Syndrome in Children: A Clinical Condition with Serious Underlying Disease

et al. 2016

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Aim Horner syndrome corresponds to the clinical triad of miosis, ptosis, and facial anhidrosis. These symptoms are related to injury of the oculosympathetic chain. In children, Horner syndrome is classified as congenital or acquired. While the diagnosis is made through clinical examination, there is some debate regarding the use of imaging modalities and the extent of anatomical coverage required. Methods Here, we describe two cases of children with acute Horner syndrome. We then review the literature about the different etiology and discuss the interest of some investigations. Results Case 1: An 8-month-old girl without personal or familial history, has presented a right acquired Horner syndrome without additional signs. Frontal chest radiography and ultrasonography of the neck and the abdomen was first achieved and returned normal. The cerebral and cervical magnetic resonance imaging (MRI) with angiographic sequences performed in a second time was also normal. Finally, an enhanced thoracic computed tomography (CT)-scan demonstrated a mass at the right pulmonary apex. Case 2: A 9-year-old boy without personal or familial history has presented an acute headache with loss of consciousness during a basketball competition. Upon waking up, the child has right hemiplegia, aphasia, and left Horner syndrome. The cerebral CT scan realized in the first line was normal. The MRI with angiographic sequences demonstrated M1 left carotid dissection with homolateral white matter infarction. Conclusion Imaging studies seem critical in delineating the nature and extent of any underlying pathology along the oculosympathetic pathway in children presenting a Horner syndrome. In these patients, a history of trauma or surgery may reduce the need for extensive systemic evaluation. Without such anamnesis, a decision to proceed with further evaluation is made with consideration of the relative incidence of tumor, especially neuroblastoma, or other treatable lesions. In this condition, MRI is the more sensitive and recommended investigation.

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“…Therefore, a lesion anywhere in the oculo-sympathetic pathway results in ipsilateral miosis and ptosis. The postganglionic fibers also innervate the facial sweat glands, hence if the injury occurs along the path of the carotid, ipsilateral anhidrosis is also seen [2]. Horner's syndrome can be congenital, acquired from trauma/mass lesion or iatrogenic from surgical manipulation.…”

Section: Introductionmentioning

confidence: 99%

Clinical Presentations of Pediatric Horner Syndrome

Smith¹,

Rathore²,

Suh³

2017

OJOph

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Purpose: To understand the multiple signs of Horner syndrome and to recommend protocols for pediatricians to obtain an accurate diagnosis of Horner syndrome. Methods: The medical records of 17 pediatric patients with Horner syndrome, neonates to eighteen years of age, were collected and analyzed. Data recorded included age, presenting symptoms, other medical history, allergies, medications, pupil size, presence of anhidrosis, and presence of ptosis. From the available pupil sizes, average degree of anisocoria was calculated. Results: All 17 patients had other clinical findings of Horner syndrome in addition to anisocoria. On initial evaluation, 100% had ptosis and 25% had anhidrosis. Of the available pupil size data, the average level of anisocoria was 2.06 mm, with a standard deviation of 1.17 mm. Conclusion: Physicians are reminded to measure pupil size to determine the degree of anisocoria when present, as it may help distinguish benign conditions from underlying pathology. Educating pediatricians on measurement of anisocoria and additional signs of Horner syndrome will help with proper referral patterns.

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Neuroimaging experience in pediatric Horner syndrome

Abstract: There are treatable causes, including malignancies, in children presenting with Horner syndrome, which justify imaging work-up of the entire oculosympathetic pathway, unless the lesion level can be determined clinically.

Cited by 19 publications

References 30 publications

Paediatric Horner’s syndrome: is investigation for underlying malignancy always required?

Paediatric Horner’s syndrome: is investigation for underlying malignancy always required?

Horner Syndrome in Children: A Clinical Condition with Serious Underlying Disease

Clinical Presentations of Pediatric Horner Syndrome

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