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Marrone S, Sanz JAA, Cacciotti G, Campione A, Boccacci F, Fraschetti F, Iacopino DG, Mastronardi L. Utility of sodium fluorescein in recurrent cervical vagus schwannoma surgery. Surg Neurol Int 2023; 14:376. [PMID: 37941611 PMCID: PMC10629342 DOI: 10.25259/sni_451_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/24/2023] [Indexed: 11/10/2023] Open
Abstract
Background Cervical schwannoma is a rare neoplasm that usually occurs like a nondolent lateral neck mass but when growing and symptomatic requires radical excision. Sodium fluorescein (SF) is a dye that is uptake by schwannomas, which makes it amenable for its use in the resection of difficult or recurrent cases. Methods We describe the case of a patient presenting with a recurrence of a vagus nerve schwannoma in the cervical region and the step-by-step technique for its complete microsurgical exeresis helped by the use of SF dye. Results We achieved a complete microsurgical exeresis, despite the presence of exuberant perilesional fibrosis, by exploiting the ability of SF to stain the schwannoma and nearby tissues. That happens due to altered vascular permeability, allowing us to better differentiate the lesion boundaries and reactive scar tissue under microscope visualization (YELLOW 560 nm filter). Conclusion Recurrent cervical schwannoma might represent a surgical challenge due to its relation to the nerve, main cervical vessels, and the scar tissue encompassing the lesion. Although SF can cross both blood-brain and blood-tumor barriers, the impregnation of neoplastic tissue is still greater than that of nonneoplastic peripheric tissues. Such behavior may facilitate a safer removal of this kind of lesion while respecting contiguous anatomical structures.
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Affiliation(s)
- Salvatore Marrone
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Università degli Studi di Palermo Scuola di Medicina e Chirurgia, Palermo, Italy
| | | | | | - Alberto Campione
- Department of Neurosurgery, Ospedale di Circolo e Fondazione Macchi di Varese, Varese
| | - Fabio Boccacci
- Department of Neurosurgery, San Filippo Neri Hospital, Rome
| | | | - Domenico Gerardo Iacopino
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Università degli Studi di Palermo Scuola di Medicina e Chirurgia, Palermo, Italy
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Eldib AA, Patil P, Nischal KK, Mitchell ER, Hiasat JG, Pihlblad MS. Safety of apraclonidine eye drops in diagnosis of Horner syndrome in an outpatient pediatric ophthalmology clinic. J AAPOS 2021; 25:336.e1-336.e4. [PMID: 34737082 PMCID: PMC8792311 DOI: 10.1016/j.jaapos.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the efficacy and systemic side effects of apraclonidine drops 0.5% in children clinically suspected of having Horner syndrome. METHODS The medical records of patients with clinically suspected Horner syndrome who underwent testing with apraclonidine 0.5% eyedrops were reviewed retrospectively. The following data were retrieved from the record: allergic reactions, somnolence, shallow respiration, pallor, or excessive fussiness noted by the examiner or parents. RESULTS A total of 46 patients presenting with anisocoria and tested with apraclonidine 0.5% were included. Of these, 15 had a positive result, with reversal of anisocoria. The mean age of patients was 3.2 years (median, 0.91; mode, 0.25 years). Twenty-four patients were ≤1 year of age; 19 were ≤6 months. No systemic side effects were noted during the examination or reported by parents in any patients. CONCLUSIONS The use of topical apraclonidine eyedrops has been described as an effective test for Horner syndrome. However, concerns have been raised regarding the potential systemic side effects in children, especially those under the age of 6 months. In our cohort, no systemic side effects were reported, including in those under 6 months of age.
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Affiliation(s)
- Amgad A Eldib
- UPMC Children's Hospital of Pittsburgh, Pediatric Ophthalmology, Strabismus, and Adult Motility, Pittsburgh, Pennsylvania; UPMC Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Preeti Patil
- UPMC Children's Hospital of Pittsburgh, Pediatric Ophthalmology, Strabismus, and Adult Motility, Pittsburgh, Pennsylvania; UPMC Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ken K Nischal
- UPMC Children's Hospital of Pittsburgh, Pediatric Ophthalmology, Strabismus, and Adult Motility, Pittsburgh, Pennsylvania; UPMC Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ellen R Mitchell
- UPMC Children's Hospital of Pittsburgh, Pediatric Ophthalmology, Strabismus, and Adult Motility, Pittsburgh, Pennsylvania; UPMC Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jamila G Hiasat
- UPMC Children's Hospital of Pittsburgh, Pediatric Ophthalmology, Strabismus, and Adult Motility, Pittsburgh, Pennsylvania; UPMC Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew S Pihlblad
- UPMC Children's Hospital of Pittsburgh, Pediatric Ophthalmology, Strabismus, and Adult Motility, Pittsburgh, Pennsylvania; UPMC Eye Center, Pittsburgh, Pennsylvania; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
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Pérez-Torres-Lobato MR, De Las Morenas-Iglesias J, Llempén-López M, Gómez-Millán-Ruiz P, Márquez-Vega C, Espiñeira-Periñán MÁ, Coronel-Rodríguez C, Franco-Ruedas C, Balboa-Huguet B, Sánchez-Vicente JL. Paediatric Horner syndrome. A case series of 14 patients in a tertiary hospital. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2020; 96:356-365. [PMID: 34217473 DOI: 10.1016/j.oftale.2020.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Horner syndrome (HS) is characterised by the triad of upper eyelid ptosis, miosis, and facial anhidrosis. Due to its wide variety of causes, it can occur at any age, and is uncommon in paediatrics. The aetiology and diagnostic approach of paediatric HS (PHS) is controversial. OBJECTIVE The purpose of this study is to describe the clinical characteristics of a 14 case series, focusing on the aetiology of HS and the clinical evolution the patients presented. METHODS A retrospective observational study was conducted on patients under 14 years-old (enrolled between 1st January 2009 and 30th April 2020). Depending on the age at diagnosis (before or after the first 5 months of life), the study cases were divided into two groups: congenital or acquired. RESULTS Fourteen patients, with a mean age of 8.5 months, were enrolled. The most frequent cause of PHS were tumours (6/14), with the most representative neoplasm being neuroblastoma (4/14). Of the acquired cases (8/14), the most frequent cause was iatrogenic (5/8), mainly secondary to cervical or thoracic surgery. The main origin of congenital HS (6/14) was neuroblastoma (4/6), being the first manifestation of the disease in 50% of patients (2/4). CONCLUSION HS may be the first sign of a major underlying disease, such as neuroblastoma. For this reason, children presenting with HS of unknown origin require imaging studies to exclude a life threatening disease. A thorough examination is essential for early diagnosis of these patients.
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Affiliation(s)
| | | | - M Llempén-López
- Hospital Universitario Virgen del Rocío, Pediatría, servicio de Oncología Pediátrica, Sevilla, Spain
| | - P Gómez-Millán-Ruiz
- Hospital Universitario Virgen del Rocío, Radiología, sección General, Sevilla, Spain
| | - C Márquez-Vega
- Hospital Universitario Virgen del Rocío, Pediatría, servicio de Oncología Pediátrica, Sevilla, Spain
| | - M Á Espiñeira-Periñán
- Hospital Universitario Virgen del Rocío, Oftalmología, sección General, Sevilla, Spain
| | | | - C Franco-Ruedas
- Hospital Universitario Virgen del Rocío, Oftalmología, sección General, Sevilla, Spain
| | - B Balboa-Huguet
- Hospital Universitario Virgen del Rocío, Oftalmología, sección Oftalmología Infantil, Sevilla, Spain
| | - J L Sánchez-Vicente
- Hospital Universitario Virgen del Rocío, Oftalmología, sección de Retina Quirúrgica, Sevilla, Spain
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Carvalho J, Maia M, Mota Á, Martins T. Congenital Horner and Scimitar syndrome in a newborn: a previously unreported combination. BMJ Case Rep 2020; 13:13/11/e238018. [DOI: 10.1136/bcr-2020-238018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Here we report a case of a term newborn presenting with left palpebral ptosis, anisocoria and heterochromia as well as cleft palate and heart murmur. Congenital Horner syndrome was suspected and a thoracoabdominal CT scan was performed to rule out neuroblastoma. This revealed an anomalous drainage of right pulmonary veins to a collector that drains to the inferior vena cava, leading to the diagnosis of Scimitar syndrome. Echocardiogram showed an ostium secundum atrial septal defect, enlarged right chambers and a dilated coronary sinus due to a persistent left superior vena cava. The combination of Horner and Scimitar syndrome has never been described before. This case should encourage clinicians to use a multidisciplinary approach in order to guarantee an adequate diagnosis and management.
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Teixeira JC, Jackson PJ. Internal Carotid Artery Dissection Presenting as Partial Horner's Syndrome and Vertigo. Mil Med 2020; 185:e1840-e1842. [PMID: 32060548 DOI: 10.1093/milmed/usaa010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/03/2019] [Accepted: 01/13/2020] [Indexed: 11/14/2022] Open
Abstract
Distinguishing between central and peripheral causes of vertigo can be challenging not only in an acute setting but also in chronic settings. A thorough review of systems and physical exam can assist providers in differentiating central versus peripheral etiologies and the need for urgent imaging. In this case, a 47-year-old man presented with vertigo, right-sided hearing loss, right-sided headache, and right-sided facial pain that began 4 weeks before while the patient was on a cruise ship. His physical exam findings were notable for anisocoria with right pupil 3.5 and left pupil 4.5, mild ptosis on the right side, positive Romberg test to the right, and Fakuda test with deviation to the right. Urgent magnetic resonance imaging revealed dissection of the right cervical internal carotid artery with a nonocclusive intramural hematoma. This case illustrates the importance of imaging in vertigo patients in which a central etiology is suspected. It further demonstrates that isolated partial Horner's or unilateral headache may indeed be the only presenting sign in a carotid dissection.
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Affiliation(s)
- Jeffrey C Teixeira
- Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889
| | - Paula J Jackson
- Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889
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LaChance MK, Fitzgerald G, Lair S, Desmarchelier MR. Horner Syndrome in Birds of Prey. J Avian Med Surg 2020; 33:381-387. [PMID: 31833306 DOI: 10.1647/2018-383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Horner syndrome, which results from oculosympathetic denervation, has rarely been reported in birds. A retrospective study was conducted in a raptor rehabilitation program to gain further insight into Horner syndrome in birds. Data from 5128 live raptors admitted over 20 years were reviewed. Horner syndrome was identified in 22 individuals from 13 different species. Raptors from the orders Strigiformes, Accipitriformes, and Falconiformes were affected, with the last order being underrepresented. Ptosis of the upper eyelid was the most commonly reported clinical sign in the birds diagnosed with Horner syndrome, having been noted in 21 cases. Signs of traumatic injury, such as fractures, wounds, and hematomas, were documented in 18 cases. Among the 22 cases, 12 birds were euthanatized, 3 died in treatment, and 7 were successfully released back into the wild.
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Affiliation(s)
- Mathieu K LaChance
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, QC J2S 2M2, Canada
| | - Guy Fitzgerald
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, QC J2S 2M2, Canada
| | - Stéphane Lair
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, QC J2S 2M2, Canada
| | - Marion R Desmarchelier
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, QC J2S 2M2, Canada
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Folkert KN, de Beaufort H, Bauman NM. Horner Syndrome from a Pediatric Otolaryngology Perspective. Ann Otol Rhinol Laryngol 2019; 129:191-194. [PMID: 31561707 DOI: 10.1177/0003489419877428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Horner syndrome is described as the clinical triad of miosis, ptosis, and anhidrosis. In pediatric patients the condition may be congenital or acquired from neoplastic, infectious or traumatic conditions, including birth trauma. Most cases of pediatric Horner syndrome present first to a pediatric ophthalmologist however since the neural pathways involve the cervical sympathetic chain otolaryngologists should understand the pathophysiology to avoid delay in management of potentially malignant cases. OBJECTIVES To aid otolaryngologists in recognizing and managing pediatric Horner syndrome by describing 3 unique cases from malignant, traumatic and/or congenital causes. METHODS Case report of 3 pediatric patients with Horner syndrome presenting to our pediatric otolaryngology department. RESULTS Case #1 is 5-month-old female with ptosis and a left level II 1.5 cm neck mass. Magnetic resonance imaging showed the mass displacing the common carotid artery and excisional biopsy revealed a poorly differentiated neuroblastoma. Case #2 is a 9-year-old female with anisocoria appearing after suffering a severe playground injury. Case #3 is a 3-year-old-male who developed ptosis and anisocoria following re-excision of a recurrent cervical lymphatic malformation. CONCLUSION Pediatric Horner syndrome may be a benign finding that is easily overlooked but may reflect a serious underlying condition. Otolaryngologists should be aware of the pathophysiology and differential diagnosis, including malignant causes, to appropriately manage patients.
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Affiliation(s)
- Kyra N Folkert
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Heather de Beaufort
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Division of Ophthalmology, Children's National Health System, Washington, DC, USA
| | - Nancy M Bauman
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Division of Otolaryngology, Children's National Health System, Washington, DC, USA
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Abstract
Horner syndrome results from an interruption of the oculosympathetic pathway. Patients with Horner syndrome present with a slightly droopy upper lid and a smaller pupil on the affected side; less commonly, there is a deficiency of sweating over the brow or face on the affected side. This condition does not usually cause vision problems or other significant symptoms, but is important as a warning sign that the oculosympathetic pathway has been interrupted, potentially with serious and even life-threatening processes. The oculosympathetic pathway has a long and circuitous course, beginning in the brain and traveling down the spinal cord to exit in the chest, then up the neck and into the orbit. Therefore, this syndrome with unimpressive clinical findings and insignificant symptoms may be a sign of serious pathology in the head, chest, or neck. This clinical review discusses how to identify the signs, confirm the diagnosis, and evaluate the many causes of Horner syndrome.
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Affiliation(s)
- Timothy J. Martin
- Department of Ophthalmology, Wake Forest University School of Medicine, Wiston-Salem, North Carolina 27157, United States
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9
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Abstract
OBJECTIVE This study aimed to present and discuss the case of a patient with known glandular fever who presented with Horner syndrome. CASE REPORT A 35-year-old patient with known glandular fever developed acute unilateral Horner syndrome, a previously undescribed complication of this common illness. Magnetic resonance imaging and magnetic resonance angiography showed that enlarged intra-carotid sheath lymphoid tissue was likely to be the underlying cause of sympathetic nerve disruption. The case is described, the anatomy of the sympathetic chain is discussed and possible alternative pathophysiological mechanisms are reviewed. CONCLUSION This is the first report in the worldwide literature of Horner syndrome arising as a result of compression from enlarged lymph nodes in glandular fever.
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10
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Neuroimaging experience in pediatric Horner syndrome. Pediatr Radiol 2015; 45:1535-43. [PMID: 25832988 DOI: 10.1007/s00247-015-3341-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/31/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Horner syndrome in children is rare. The frequency and spectrum of malignancy as the cause of Horner syndrome in children remains unclear. Also unclear is whether the imaging work-up should include the entire oculo-sympathetic pathway or should be more targeted. In addition, the value of cross-sectional angiographic imaging in Horner syndrome is uncertain. OBJECTIVE To review imaging pathology in a cohort of children with Horner syndrome at a major academic pediatric medical center. MATERIALS AND METHODS We reviewed a 22-year period of CT and MR imaging studies in children with a clinical diagnosis of Horner syndrome referred for imaging. RESULTS We found 38 patients who fulfilled study criteria of Horner syndrome and 6/38 had relevant imaging findings: 2/6 etiologies were neoplastic (congenital neuroblastoma and central astrocytoma), 1/6 had a vascular abnormality (hypoplastic carotid artery), 1/6 had maldevelopment (Chiari I malformation), and 2/6 had inflammatory/traumatic etiology (viral cervical lymphadenopathy, post jugular vein cannulation). There was a similar number of congenital and acquired pathologies. The malignancies were found at any level of the oculosympathetic pathway. CONCLUSION 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.
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Abstract
Horner syndrome consists of unilateral ptosis, an ipsilateral miotic but normally reactive pupil, and in some cases, ipsilateral facial anhidrosis, all resulting from damage to the ipsilateral oculosympathetic pathway. Herein, we review the clinical signs and symptoms that can aid in the diagnosis and localization of a Horner syndrome as well as the causes of the condition. We emphasize that pharmacologic testing can confirm its presence and direct further testing and management.
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Affiliation(s)
- Sivashakthi Kanagalingam
- Department of Ophthalmology.,Department of Neurology.,Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Neil R Miller
- Department of Ophthalmology.,Department of Neurology.,Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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12
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Abstract
Eye drops can help to diagnose and prevent complications of neurological disorders. Guttae ophthalmicae (eye drops) are generally safe because the drugs rarely achieve significant systemic concentrations, although there are rare exceptions. This article covers contemporary pharmacological pupil testing; how to dilate a pupil safely; common reasons why pupils do not respond to drops; and corneal lubrication to prevent complications of weak eye closure.
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Affiliation(s)
- Luke Bennetto
- Department of Neurology, Frenchay Hospital, , Bristol, UK
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M C, A A, C G, O I, Ov O, H G, H O. Irreversible Horner's syndrome diagnosed by aproclonidine test due to benign thyroid nodule. Pak J Med Sci 2013; 29:224-6. [PMID: 24353546 PMCID: PMC3809183 DOI: 10.12669/pjms.291.2732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 10/12/2012] [Indexed: 11/15/2022] Open
Abstract
We are reporting an irreversible Horner Syndrome (HS) in a patient with benign thyroid gland nodule in which thyroidectomy was performed for treatment. A 37-year-old female was admitted to our clinic with a swelling in the left lobe of the thyroid gland and ptosis at the left eyelid. The clinical diagnosis of HS was confirmed pharmacologically by aproclonidine. Histopathologic examination of thyroidectomy specimen was reported as benign nodule. To the best of our knowledge, this is a very rare report in terms of thyroid benign nodule associated with irreversible HS due to cervical sympathetic chain compression.
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Affiliation(s)
- Coskun M
- Coskun M, Department of Ophthalmology, Mustafa Kemal University, Medical Faculty, Hatay, Turkey
| | - Aydogan A
- Aydogan A, Department of General Surgery, Mustafa Kemal University, Medical Faculty, Hatay, Turkey
| | - Gokce C
- Gokce C, Department of Endocrinology, Mustafa Kemal University, Medical Faculty, Hatay, Turkey
| | - Ilhan O
- Ilhan O, Department of Ophthalmology, Mustafa Kemal University, Medical Faculty, Hatay, Turkey
| | - Ozkan Ov
- Ozkan OV, Department of General Surgery, Mustafa Kemal University, Medical Faculty, Hatay, Turkey
| | - Gokce H
- Gokce H, Department of Pathology, Mustafa Kemal University, Medical Faculty, Hatay, Turkey
| | - Oksuz H
- Oksuz H, Department of Ophthalmology, Mustafa Kemal University, Medical Faculty, Hatay, Turkey
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Hirji N, Shouls G, Ali N. The Risk of Neuroblastoma in Paediatric Horner Syndrome—A Systematic Reappraisal of the Literature. Neuroophthalmology 2012. [DOI: 10.3109/01658107.2012.730094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
The diagnosis of Horner syndrome (HS) using apraclonidine eye drops is an alternative to the use of topical cocaine drops. A number of reports have described the efficacy of apraclonidine testing, but there is some debate over its sensitivity in the acute setting. We describe a patient with HS secondary to carotid dissection who had a positive response to apraclonidine 3 hours after the onset of symptoms. The case is made for a larger study of apraclonidine use to determine its true sensitivity and specificity, identify confounding factors, and redefine the criteria for positive testing.
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Traumatic Ptosis and Mydriasis Masking Horner Syndrome From an Internal Carotid Pseudoaneurysm. Ophthalmic Plast Reconstr Surg 2011; 27:e92-4. [DOI: 10.1097/iop.0b013e3181f0b228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cervasio K. The role of the pediatric home healthcare nurse. HOME HEALTHCARE NURSE 2010; 28:424-431. [PMID: 20592542 DOI: 10.1097/nhh.0b013e3181e32522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The acuity and number of children with life-threatening, life-limiting, and chronic conditions has increased dramatically over the past decade. The pediatric home care nurse needs a special body of knowledge and repertoire of tools to accurately assess, intervene, manage, evaluate, and provide resources to this most vulnerable population. Inherent in caring for these children is the need to support the family, nurturing the parents who care for chronically ill children at home.
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Affiliation(s)
- Kathleen Cervasio
- Long Island University, School of Nursing, Brooklyn, New York 11214, USA.
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Smith SJ, Diehl N, Leavitt JA, Mohney BG. Incidence of pediatric Horner syndrome and the risk of neuroblastoma: a population-based study. ACTA ACUST UNITED AC 2010; 128:324-9. [PMID: 20212203 DOI: 10.1001/archophthalmol.2010.6] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To describe the incidence of pediatric Horner syndrome and the risk of occult malignancy in a population-based cohort. METHODS The medical records of all pediatric patients (aged <19 years) residing in Olmsted County, Minnesota, who received diagnoses of Horner syndrome from January 1, 1969, through December 31, 2008, were retrospectively reviewed. RESULTS Horner syndrome was diagnosed in 20 pediatric patients during the 40-year period, yielding an age- and sex-adjusted incidence of 1.42 per 100 000 patients younger than 19 years of age (95% confidence interval [CI], 0.80-2.04). Eleven of the 20 patients (55%) had a congenital onset, for a birth prevalence of 1 in 6250 (95% CI, 3333-10 000), while the remaining 9 (45%) had acquired syndromes. Seven of the 11 (63.6%) patients with congenital cases had a history of birth trauma, while the remaining 4 (36.4%) had no identifiable cause. Six of the 9 (66%) acquired cases occurred following surgery or trauma, while the remaining 3 (33%) had no known etiology. None of the 20 patients (95% CI, 0.0%-16.8%) were found to have a neuroblastoma or other malignancy during a mean follow-up of 56.5 months (range, 0-256.9 months). CONCLUSIONS The incidence of pediatric Horner syndrome in this population was 1.42 per 100 000 patients younger than 19 years, with a birth prevalence of 1 in 6250 for those with a congenital onset. Birth, surgical, or other trauma occurred in 13 (65%) of the patients, while none were found to have an underlying mass lesion, suggesting a need for reappraising current recommendations for extensive evaluations in these patients.
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Affiliation(s)
- Stephen J Smith
- Mayo Clinic College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Abstract
OBJECTIVES To demonstrate the importance of thorough investigation of patients with Horner syndrome, and to explain the relevant anatomy. CASE REPORT A 46-year-old man presented with right-sided Horner syndrome. No other abnormality was found. Magnetic resonance imaging showed calcification of the stylohyoid ligament, with a pseudoarthrosis in the mid-portion of the ligament. This pseudoarthrosis was displacing and compressing the internal carotid artery and the adjacent sympathetic chain, causing Horner syndrome. CONCLUSION In this case, magnetic resonance imaging was invaluable in elucidating the cause of the Horner syndrome. This is the first described case of pseudoarthrosis of a calcified stylohyoid ligament causing Horner syndrome.
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Herrero-Morín J, Calvo Gómez-Rodulfo A, García López E, Fernández González N, García Riaño L, Rodríguez García G. Síndrome de Horner congénito. An Pediatr (Barc) 2009; 70:306-8. [DOI: 10.1016/j.anpedi.2008.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 11/14/2008] [Accepted: 11/17/2008] [Indexed: 10/20/2022] Open
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Pupillary Autonomic Neuropathy Simulating Partial Horner Syndrome in Diabetes Mellitus and Its Reversal With Control of Blood Glucose. J Neuroophthalmol 2008; 28:241-2. [DOI: 10.1097/wno.0b013e31818333ab] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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