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Dallalzadeh LO, Robillard EG, Goodyear K, Khitri MR. Eyelid, Orbital, and Lacrimal Disorders in the Neonate. Neoreviews 2023; 24:e616-e625. [PMID: 37777617 DOI: 10.1542/neo.24-10-e616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Liane O Dallalzadeh
- Division of Pediatric Ophthalmology and Strabismus, Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA
| | - Emily G Robillard
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA
| | - Kendall Goodyear
- Division of Pediatric Ophthalmology and Strabismus, Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA
| | - Monica R Khitri
- Division of Pediatric Ophthalmology and Strabismus, Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA
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2
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Maamouri R, Ferchichi M, Houmane Y, Gharbi Z, Cheour M. Neuro-Ophthalmological Manifestations of Horner's Syndrome: Current Perspectives. Eye Brain 2023; 15:91-100. [PMID: 37465361 PMCID: PMC10351587 DOI: 10.2147/eb.s389630] [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: 04/01/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
Horner's syndrome (HS) is caused by a damage to the oculosympathetic pathway. HS may be congenital, but it is usually acquired and may reveal a life-threatening condition. According to the anatomic location of the underlying pathologic process, HS is classified as central, pre- or postganglionic, when the lesion affects the first, second or third-order neuron, respectively. Pharmacological testing, if available, can be used to differentiate HS from « pseudo-HS » in patients with mild symptoms. Given the financial burden that imaging of the entire oculosympathetic pathway represents, a targeted imaging approach is advised. Although in the majority of cases, clinical examination may predict etiology, in other cases pharmacological testing can help in the localization process. We searched PubMed data base for papers published before December 2022 that concerned Horner's syndrome, its neuro-ophthalmological manifestations and diagnosis. In this article, we describe the main neuro-ophthalmological manifestations of the three types of HS, the most common etiologies, and a targeted diagnostic strategy in each type.
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Affiliation(s)
- Rym Maamouri
- Department of Ophthalmology, Habib Thameur Hospital, Tunis, Tunisia
| | - Molka Ferchichi
- Department of Ophthalmology, Habib Thameur Hospital, Tunis, Tunisia
| | - Yasmine Houmane
- Department of Ophthalmology, Habib Thameur Hospital, Tunis, Tunisia
| | - Zaineb Gharbi
- Department of Ophthalmology, Habib Thameur Hospital, Tunis, Tunisia
| | - Monia Cheour
- Department of Ophthalmology, Habib Thameur Hospital, Tunis, Tunisia
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Grabala P, Danowska-Idziok K, Helenius IJ. A Rare Complication of Thoracic Spine Surgery: Pediatric Horner's Syndrome after Posterior Vertebral Column Resection-A Case Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010156. [PMID: 36670706 PMCID: PMC9857723 DOI: 10.3390/children10010156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/08/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Horner's syndrome (HS) classically consists of the symptom triad of miosis, ptosis, and anhidrosis. It is caused by impairment of a certain pathway in the sympathetic nervous system. It may also appear as part of the clinical signs of other diseases and syndromes, including Pancoast tumors, intradural and/or epidural tumors, thoracic outlet syndrome, syringomyelia, brachial plexus injury, and aortic dissection. Here, we report a very rare complication of vertebral column resection in children, and we present the clinical findings of a case of Horner's syndrome with a current literature review. CASE PRESENTATION A five-year-old child with severe congenital kyphoscoliosis qualified for surgical treatment of the spinal deformity via a posterior approach, with three-column osteotomy and fusion. RESULTS After successful surgery, the patient presented with HS due to distraction of the sympathetic nerve trunk and, thus, innervation to the left eye. At the 4-year follow-up, the child had fully recovered. CONCLUSIONS Pediatric HS after posterior instrumented scoliosis correction surgery with posterior vertebral column resection of the thoracic spine is very rare. This is the first reported case of HS after posterior vertebral column resection and spinal fusion for congenital kyphoscoliosis without the use of epidural analgesia. Symptom resolution may be variable and, in some cases, delayed.
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Affiliation(s)
- Pawel Grabala
- University Children’s Hospital, Department of Pediatric Orthopedic Surgery and Traumatology, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland
- Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland
- Correspondence:
| | - Kinga Danowska-Idziok
- University Children’s Hospital, Department of Pediatric Orthopedic Surgery and Traumatology, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland
| | - Ilkka J. Helenius
- Department of Orthopedics and Traumatology, Helsinki University Hospital, 00260 Helsinki, Finland
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4
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Neuroblastoma: Essential genetic pathways and current therapeutic options. Eur J Pharmacol 2022; 926:175030. [DOI: 10.1016/j.ejphar.2022.175030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/29/2022]
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5
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The evaluation of patient demographics, etiologies and apraclonidine test results in adult Horner's syndrome. Int Ophthalmol 2021; 42:1233-1239. [PMID: 34718919 DOI: 10.1007/s10792-021-02109-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE We aimed to demonstrate the patient demographics, etiologies and apraclonidine test results in adult Horner's syndrome. METHODS This retrospective study was performed by the analysis of medical data of patients who were given 0.5% apraclonidine test. Patients' past medical history, demographic data, etiologies, accompanying neurological findings and pharmacological test results were assessed. RESULTS Forty patients (21 females and 19 males) with a mean age of 50.3 ± 11.6 years were evaluated. Apraclonidine 0.5% test was positive in 37 patients (92.5%). An etiology could be identified in 20 patients (central [9 patients, 45%], preganglionic [9 patients, 45%] and postganglionic [2 patients, 10%]). Neurological findings accompanying Horner's syndrome were present in 8 patients. CONCLUSION Despite detailed investigations, in a significant number of patients with Horner's syndrome an underlying cause may not be detected. Among the identifiable lesions, central and preganglionic involvements are still the first leading causes of Horner's syndrome. In addition, apraclonidine test may not be positive in all patients and a negative response does not exclude Horner's syndrome.
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Miyata K, Akaihata M, Shimomura Y, Hori T, Kaneko K, Okumura A. Harlequin syndrome associated with ganglioneuroblastoma-induced Horner syndrome. Childs Nerv Syst 2021; 37:2683-2686. [PMID: 33125512 DOI: 10.1007/s00381-020-04948-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022]
Abstract
A 1-year-old boy presented with a 4-month history of hypertension, ptosis of the right upper eyelid, left hemifacial sweating, and flushing. He was diagnosed with Harlequin syndrome associated with Horner syndrome. Computed tomography revealed a mass lesion in the right superior mediastinum. Therefore, the patient underwent total tumor resection. Histological examination demonstrated ganglioneuroblastoma. The MYCN oncogene was not amplified, and the mitosis-karyorrhexis index was low. Accordingly, radiation and chemotherapy were not performed. No recurrence was observed within 8 months after surgery, and the patient's blood pressure was normalized. However, the ptosis, hemifacial sweating, and flushing persisted.
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Affiliation(s)
- Kenji Miyata
- Department of Pediatrics, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Mitsuko Akaihata
- Department of Pediatrics, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yasuto Shimomura
- Department of Pediatrics, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Toshinori Hori
- Department of Pediatrics, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenitiro Kaneko
- Department of Gastrointestinal Surgery, Aichi Medical University, School of Medicine, Nagakute, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Choi JH, Ro JY. Mediastinal neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: Pathology review and diagnostic approach. Semin Diagn Pathol 2021; 39:120-130. [PMID: 34167847 DOI: 10.1053/j.semdp.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 12/13/2022]
Abstract
Neuroblastic tumors are a group of tumors of the sympathetic ganglia and adrenal medulla that derive from primordial neural crest cells. These tumors include neuroblastoma, intermixed ganglioneuroblastoma, nodular ganglioneuroblastoma, and ganglioneuroma. Neuroblastomas are the most common extracranial solid tumor arising in childhood and may occur in different anatomic sites. Neuroblastic tumors are common mesenchymal tumors of the mediastinum. Herein, we describe advances in our understanding of neuroblastic tumor biology. Pathologists should be aware of diagnostic challenges associated with these tumors to ensure correct histologic diagnosis and appropriate clinical management. We describe updated mediastinal neuroblastic tumor pathology, focusing on morphological, immunohistochemical, and molecular features and differential diagnoses.
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Affiliation(s)
- Joon Hyuk Choi
- Department of Pathology, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Namgu, Daegu, 42415, South Korea.
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, 77030, USA
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Cherayil NR, Tamhankar MA. Neuro-Ophthalmology for Internists. Med Clin North Am 2021; 105:511-529. [PMID: 33926644 DOI: 10.1016/j.mcna.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Neuro-ophthalmology is the study of the neurologic underpinnings of vision and includes a fascinating variety of disorders that span the broad spectrum of ophthalmic and neurologic disease. This subspecialty relies heavily on accurate neuroanatomic localization and examination. This article discusses neuro-ophthalmic complaints that frequently present to the internist, including acute vision loss, double vision, and unequal pupils. It focuses on pertinent clinical features of the most common causes of these chief complaints and additionally highlights salient points of history, diagnosis, examination, and management with special emphasis on the signs and symptoms that should prompt expedited evaluation.
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Affiliation(s)
- Neena R Cherayil
- Department of Neurology, Northwestern University, 259 E. Erie St, Ste 1520, Chicago, IL 60611, USA; Department of Ophthalmology, Northwestern University, Chicago, IL, USA.
| | - Madhura A Tamhankar
- Department of Ophthalmology, University of Pennsylvania, 51 N 39th St, Philadelphia, PA 19104, USA
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Abstract
Horner syndrome is an uncommon but important clinical entity, representing interruption of the sympathetic pathway to the eye and face. Horner syndrome is almost always diagnosed clinically, though pharmacological testing can be used to confirm the diagnosis. Imaging modalities such as PET, CT and MRI are important components of work-up for patients presenting with acquired Horner syndrome. Our patient's presentation with Horner syndrome unmasked the causative superior sulcus squamous cell carcinoma and a coincidental lower lobe adenocarcinoma. Successful radical treatment of these cancers resulted in complete resolution of the syndrome and disease-free survival at 18 months. We review the anatomy and pathophysiology underlying this and other causes of Horner syndrome.
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Affiliation(s)
- Yu X Kong
- Cardiothoracic Care Centre, Fitzroy, Victoria, Australia
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10
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Rootman MS, Dotan G, Konen O. Neuroimaging in Children with Ophthalmological Complaints: A Review. J Neuroimaging 2021; 31:446-458. [PMID: 33615595 DOI: 10.1111/jon.12842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/27/2022] Open
Abstract
Pediatric patients are commonly referred to imaging following abnormal ophthalmological examinations. Common indications include papilledema, altered vision, strabismus, nystagmus, anisocoria, proptosis, coloboma, and leukocoria. Magnetic resonance imaging (MRI) of the brain and orbits (with or without contrast material administration) is typically the imaging modality of choice. However, a cranial CT scan is sometimes initially performed, particularly when MRI is not readily available. Familiarity with the various ophthalmological conditions may assist the radiologist in formulating differential diagnoses and proper MRI protocols afterward. Although MRI of the brain and orbits usually suffices, further refinements are sometimes warranted to enable suitable assessment and accurate diagnosis. For example, the assessment of children with sudden onset anisocoria associated with Horner syndrome will require imaging of the entire oculosympathetic pathway, including the brain, orbits, neck, and chest. Dedicated orbital scans should cover the area between the hard palate and approximately 1 cm above the orbits in the axial plane and extend from the lens to the midpons in the coronal plane. Fat-suppressed T2-weighted fast spin echo sequences should enable proper assessment of the globes, optic nerves, and perioptic subarachnoid spaces. Contrast material should be given judiciously, ideally according to clinical circumstances and precontrast scans. In this review, we discuss the major indications for imaging following abnormal ophthalmological examinations.
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Affiliation(s)
- Mika Shapira Rootman
- Department of Radiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University
| | - Gad Dotan
- Ophthalmology Unit, Schneider Children's Medical center of Israel, Petac Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University
| | - Osnat Konen
- Department of Radiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University
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11
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Khalatbari H, Ishak GE. Imaging of Horner syndrome in pediatrics: association with neuroblastoma. Pediatr Radiol 2021; 51:205-215. [PMID: 33025064 DOI: 10.1007/s00247-020-04796-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/23/2020] [Accepted: 08/04/2020] [Indexed: 11/25/2022]
Abstract
Neuroblastoma is the most common neoplasm associated with pediatric Horner syndrome. The laboratory and imaging evaluation of isolated pediatric Horner syndrome is controversial. We review the literature published in the last several decades and present the rationale for the imaging work-up in this patient cohort.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Gisele E Ishak
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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12
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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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Bhate M, Flaherty M, Rowe N, Howman-Giles R. Paediatric Horner Syndrome: How much further to investigate? Indian J Ophthalmol 2020; 68:2607-2610. [PMID: 33120710 PMCID: PMC7774181 DOI: 10.4103/ijo.ijo_1603_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We report an infant with an early-onset Horner syndrome and normal urinary catecholamine levels. Further investigations with Nuclear medicine imaging with 123I-MIBG (meta-iodo benzyl-guanidine) confirmed a right thoracic inlet mass consistent with a neuroblastoma, a tumor of neural crest origin. The authors emphasize the need for investigating idiopathic acquired pediatric Horner syndrome and the value of an MIBG scan as a diagnostic test for suspected neuroblastoma.
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Affiliation(s)
- Manjushree Bhate
- Jasti V Ramanamma Children's Eye Care Centre L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Maree Flaherty
- Department of Ophthalmology Children's Hospital, Westmead, Australia
| | - Neil Rowe
- Department of Ophthalmology Children's Hospital, Westmead, Australia
| | - Robert Howman-Giles
- Department of Nuclear Medicine Children's Hospital, Westmead; Division of Imaging Sydney Medical School, University of Sydney, Sydney, Australia
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Han J, Park SY, Lee JY. Nationwide population-based incidence and etiologies of pediatric and adult Horner syndrome. J Neurol 2020; 268:1276-1283. [PMID: 33090271 DOI: 10.1007/s00415-020-10270-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine age- and sex-specific incidence and possible etiologies of pediatric and adult Horner syndrome in South Korea. METHODS A nationwide, population-based, cohort study using data from the Korean National Health Claims database from 2007 to 2018. All patients with Horner syndrome from the entire Korean population (n = 51,629,512) were included. To find possible causes of Horner syndrome, we searched concurrent codes for systemic diseases, trauma, or surgical procedures. RESULTS A total of 139 pediatric patients (59.7% male) and 1331 adults (51.0% male) were newly diagnosed as having Horner syndrome. The cumulative incidence was 2.12 (95% CI 2.08-2.17) per 100,000 pediatric population and 2.95 (2.94-2.96) per 100,000 adults. The peak incidence occurred at 0-4 years of age in the pediatric population, and at 50-54 years in the adult population. A total of 835 (56.8%) patients had underlying conditions or related surgical procedures associated with Horner syndrome. The underlying causes were recognized in 695 (83.2%) patients before the diagnosis of Horner syndrome, in 75 (9.0%) patients at the same time as the Horner syndrome diagnosis, and in 65 (7.8%) patients after the diagnosis of Horner syndrome. There were four cases of Horner syndrome that preceded neuroblastoma diagnosis. The most common tumor related with Horner syndrome was that of the thyroid in the adult population. CONCLUSIONS This study determined the estimated incidence and possible causes of pediatric and adult Horner syndrome. As Horner syndrome with unknown etiologies may harbor serious malignancy, extensive evaluations are required, especially in children.
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Affiliation(s)
- Jinu Han
- Institute of Vision Research, Gangnam Severance Hospital, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Ju-Yeun Lee
- Department of Ophthalmology, Myongji Hospital, Hanyang University College of Medicine, 55, Hwasu-ro 14, Deogyang-gu, Goyang-si, Gyeonggi-do, 10475, Republic of Korea. .,Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
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15
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LimFat GJ, Kukreti V. Visual Diagnosis: Rapid Deterioration of Respiratory Status and Lower Limb Hypotonia in a 6-month-old Infant. Pediatr Rev 2020; 41:e37-e41. [PMID: 33004671 DOI: 10.1542/pir.2017-0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Guillaume J LimFat
- Undergraduate Medicine, Queen's University School of Medicine, Kingston, ON, Canada
| | - Vinay Kukreti
- Department of Pediatrics, Queen's University School of Medicine, Kingston General Hospital, Kingston, ON, Canada.,Department of Pediatrics, Lakeridge Health Oshawa, Oshawa, ON, Canada
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16
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Graef S, Chiu HH, Wan MJ. The risk of a serious etiology in pediatric Horner syndrome: indications for a workup and which investigations to perform. J AAPOS 2020; 24:143.e1-143.e6. [PMID: 32522708 DOI: 10.1016/j.jaapos.2020.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/27/2020] [Accepted: 02/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the risk of a serious etiology in a cohort of children with Horner syndrome without a known cause at presentation. METHODS The medical records of children (<18 years of age) with Horner syndrome of unknown etiology at presentation who underwent a workup at a single tertiary-care pediatric hospital over a 20-year period were reviewed retrospectively. RESULTS A total of 48 patients with Horner syndrome were included. Median age at diagnosis was 12 months (range, 1 month to 17 years). A serious etiology was discovered in 7 (15%): neuroblastoma in 5, nasopharyngeal carcinoma in 1, and desmoid tumor in 1. Other causes were congenital/idiopathic (27 [56%]), acquired/idiopathic (10 [21%]), and likely birth trauma (4 [8%]). In 3 patients with a serious etiology, there were significant clinical manifestations of the pathology in addition to Horner syndrome. In the other 4 cases with a serious etiology (all neuroblastoma), the patients presented with Horner syndrome in isolation, and the tumor was discovered during a routine workup. All 5 neuroblastoma cases presented before 5 years of age; urine catecholamines were elevated in 4 of the 5. Imaging revealed mass lesions in the neck or upper chest in all 7 cases with a serious etiology. CONCLUSIONS In children presenting with Horner syndrome of unknown cause, there is a small but nontrivial risk of a serious underlying etiology. When a young child presents with Horner syndrome in isolation, urine catecholamine testing and imaging of the oculosympathetic pathway are recommended to rule out neuroblastoma.
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Affiliation(s)
- Sybille Graef
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Hannah H Chiu
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Wan
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
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Atypical Horner's syndrome: frequency, features and aetiology in a paediatric population. Eye (Lond) 2020; 35:811-816. [PMID: 32424330 DOI: 10.1038/s41433-020-0967-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES Paediatric Horner's syndrome (HS) may present atypically with incomplete or intermittent clinical features, yet could represent sinister pathology including neuroblastoma. We aim to report the frequency and features with which atypical HS presents in our population (Northern Ireland) and to propose an investigation algorithm to aid diagnosis in these challenging cases. SUBJECTS/METHODS Retrospective chart review of all paediatric anisocoria and HS cases presenting to Belfast, Northern Ireland, between 2012 and 2018, identified through searching our paediatric ophthalmology database. RESULTS Sixty-one eligible cases of anisocoria or HS were analysed. Ten cases of HS were identified, four (40%) of which presented atypically with incomplete or intermittent features. Two of these four atypical cases were secondary to neuroblastoma. Overall incidence of paediatric HS in Northern Ireland during the study period was at least 2.54 per 100,000. CONCLUSIONS Paediatric HS may present atypically in a significant number of cases. Accordingly, clinicians should consider HS in children with a history of anisocoria or ptosis and have a low threshold for use of pharmacological tests to aid diagnosis.
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Braungart S, Craigie RJ, Farrelly P, Losty PD. Paediatric Horner's syndrome: is investigation for underlying malignancy always required? Arch Dis Child 2019; 104:984-987. [PMID: 31186293 DOI: 10.1136/archdischild-2019-317007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Horner'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. METHODS Systematic review of the literature (PubMed and Ovid/Medline database, 1961-2018). RESULTS The 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. CONCLUSION HS 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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Affiliation(s)
- Sarah Braungart
- Department of Pediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.,Department of Paediatric Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ross J Craigie
- Department of Paediatric Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Paul Farrelly
- Department of Paediatric Surgery, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Paul Damian Losty
- Department of Pediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.,Institute of Child Health, University of Liverppol, Liverpool, Merseyside, UK
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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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Ocak S, Kebudi R, Cebeci Z, Buyukbabani N, Bilgic B, Tuncer S. Neuroblastoma of the Iris in Children. J Pediatr Ophthalmol Strabismus 2019; 56:e12-e16. [PMID: 30747977 DOI: 10.3928/01913913-20190125-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 11/02/2018] [Indexed: 11/20/2022]
Abstract
Neuroblastoma of the iris is an extremely rare clinical entity. An otherwise healthy 2-month-old male infant presented to the oncology clinic with a nodular whitish iris lesion in his right eye. The excisional tumor biopsy was consistent with a pathological diagnosis of neuroblastoma with differentiation and negative MYCN gene mutation. Further systemic evaluation revealed a right adrenal mass with no metastatic lesion. The biopsy of the adrenal lesion was also consistent with neuroblastoma. After four courses of chemotherapy, the adrenal mass was completely resected. The patient underwent two additional courses of postoperative chemotherapy and continued retinoic acid treatment. The patient is under regular follow-up with no evidence of recurrence 36 months after the initial diagnosis. This is the first case report to present a histopathological verification of neuroblastoma of the iris. The authors suggest that neonates and infants who are diagnosed as having neuroblastoma undergo an ophthalmologic examination after the initial diagnosis to investigate the true incidence of small iris lesions in neuroblastoma that may have been unrecognized. Neuroblastoma should be included in the differential diagnosis of amelanotic iris lesions in infants and young children. [J Pediatr Ophthalmol Strabismus. 2019;56:e12-e16.].
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Bremner F. Apraclonidine Is Better Than Cocaine for Detection of Horner Syndrome. Front Neurol 2019; 10:55. [PMID: 30804875 PMCID: PMC6371044 DOI: 10.3389/fneur.2019.00055] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/16/2019] [Indexed: 11/25/2022] Open
Abstract
Background: In suspected cases of Horner syndrome pharmacological confirmation is often required before embarking on further investigations. There are two drugs currently used for this purpose that are commercially available for topical administration: cocaine (2-10%) and apraclonidine (0.5-1.0%). Aims: To evaluate and compare the effects of both drugs in normal eyes and eyes with Horner syndrome Methods: This is a retrospective study looking at the outcome of 660 consecutive pharmacological tests with these two drugs in one tertiary referral center over 14 years. Eyes were categorized as "normal" or "Horner syndrome" based on non-pharmacological criteria (pupillometric and clinical evidence). Pupil diameters in the dark and in bright light were measured by pupillometry before and 40 min after administration of the test drug (either 4% cocaine or 0.5% apraclonidine). Results: Cocaine dilated the normal pupil (measured in bright light: mean +2.1 mm, range -0.4 to +3.9 mm; 95% lower limit +0.5 mm); the extent of this response was not significantly affected by patient age or pupil size, but was 50% less in brown eyes compared with blue or green eyes, and 20% less if the measurements were made in the dark. In eyes with Horner syndrome cocaine had significantly less mydriatic effect (mean +0.7 mm, range -0.7 to +2.9 mm). Apraclonidine constricted the normal pupil (measured in the dark: mean -0.4 mm, range -1.3 to +0.8 mm; 95% upper limit +0.1 mm); eye color made no difference but the response was significantly greater in younger patients and larger pupils and significantly less if measured in bright lighting conditions. In eyes with Horner syndrome apraclonidine dilated the pupil (mean +0.6, range -0.4 to +2.3 mm). Applying the 95% limits identified from my normative data, I estimate the sensitivity of each drug test for detection of Horner syndrome at 40% for cocaine (criterion for abnormal: mydriasis ≤0.5 mm when measured in the dark) compared with 93% for apraclonidine (criterion for abnormal: mydriasis ≥0.1 mm when measured in the dark). Conclusions: Apraclonidine is a more sensitive test than cocaine for detection of Horner syndrome, and should be adopted as the new gold standard in routine clinical practice. However, caution is needed when using this drug within hours of a suspected sympathetic lesion, or in infants under 1 year of age.
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Affiliation(s)
- Fion Bremner
- Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Kardon R, Bremner F. Pharmacologic Pupil Testing and Imaging for Horner Syndrome. Neuroophthalmology 2019. [DOI: 10.1007/978-3-319-98455-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
A 3-month-old male developed intermittent left upper eyelid ptosis at the age of 1 month that was gradually increasing in frequency and duration. Examination revealed anisocoria and left upper and lower eyelid ptosis, consistent with a left Horner syndrome. Imaging showed a mass in the left superior posterior mediastinum, which was resected, and pathology was consistent with neuroblastoma. Eight months thereafter, the patient underwent left upper eyelid ptosis repair. Cases of infantile acquired Horner syndrome due to neuroblastoma are rare. To the authors' knowledge, there has only been one case described that presented with intermittent symptoms. The authors report the second case of intermittent acquired Horner syndrome due to neuroblastoma. This case demonstrates the importance of recognizing that Horner syndrome may present with subtle and intermittent symptoms. In a pediatric patient, one should maintain suspicion for neuroblastoma.
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Abstract
Horner syndrome was identified in 25 of 30 777 avian admissions to Currumbin Wildlife Hospital during 2010-2016. Unilateral ptosis and erection of facial feathers were distinct findings on physical examination and consistent across 9 species. Affected birds were biased toward adults (64%) suffering traumatic injuries (88%). Concurrent injuries requiring treatment were present in 38% of cases, and 76% had additional neurologic deficits. Prognosis for release was poor, with an overall success rate of 32%. Resolution of clinical signs increased to 44% with higher doses of meloxicam and required an average hospitalization of 22 days (range, 3-78 days). Further investigation of the underlying causes of Horner syndrome in birds to provide treatment and prognostic guidelines is warranted.
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Abstract
PURPOSE To present the management of three patients suffering from ptosis of various etiologies, with scleral contact lenses. MATERIAL AND METHODS Three patients (five eyes) with ptosis resulting from levator dehiscence due to long-term rigid gas permeable contact lens wear for keratoconus, phthisis bulbi, and myopathy due to Kearns-Sayre syndrome were identified during a 2-year period. They were fitted with scleral contact lenses in order to provide cosmesis by lifting the upper eyelid with the bulk of the lens, and simultaneously provide vision correction where applicable. RESULTS The scleral contact lenses provided comfortable wear, significantly improved cosmesis as both palpebral aperture and marginal reflex distance were increased, and visual acuity was also subjectively and objectively improved. Two of the patients opted for the scleral contact lenses, whereas the parents of the third patient, a 10-year-old girl with Kearns-Sayre syndrome, chose to undergo ptosis surgery due to handling issues of the scleral contact lenses. CONCLUSION Scleral contact lenses can be a useful addition to the treatment option for patients with complicated ptosis.
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Affiliation(s)
| | | | - Ioannis Mavrikakis
- a Department of Oculoplastics and Orbit , Athens Eye Hospital , Glyfada , Greece
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Ott C, Bobylev A, Holland-Cunz SG, Mayr J. Unilateral Straight Hair-A Symptom of Acquired Horner's Syndrome in a Neonate. European J Pediatr Surg Rep 2018; 6:e32-e36. [PMID: 29632800 PMCID: PMC5889299 DOI: 10.1055/s-0038-1639479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/08/2018] [Indexed: 12/12/2022] Open
Abstract
A multicystic tumor of the right neck was detected in a girl at 29 weeks of gestation by fetal ultrasound and magnetic resonance imaging (MRI). The baby was delivered by cesarean section at week 37 of gestation. The newborn adapted well, with minimal compromise of breathing and drinking. Postnatal ultrasound and MRI revealed a cervical lymphangioma measuring 60.5 × 60.6 × 41.2 mm. We performed subtotal resection of the tumor when the girl was 34 days. As a complication of surgical resection, the girl developed ipsilateral Horner's syndrome. In the postoperative period, her curled hair turned straight at the side of the head affected by Horner's syndrome. At the age of 2.5 years, ultrasonic imaging revealed the presence of three cysts measuring 3 mm in diameter each. Horner's syndrome had improved, and the texture of the girl's hair had become curly again on both sides.
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Affiliation(s)
- Chantal Ott
- Department of Pediatric Surgery, University Children's Hospital Basel, Basel, Switzerland
| | - Andrei Bobylev
- Department of Pediatric Surgery, University Children's Hospital Basel, Basel, Switzerland
| | | | - Johannes Mayr
- Department of Pediatric Surgery, University Children's Hospital Basel, Basel, Switzerland
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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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Avila A, Liu J, Kohen MC. Horner Syndrome After Epidural Catheter Placement in a 4-Month-Old Child. J Pediatr Ophthalmol Strabismus 2018; 55:e1-e3. [PMID: 29384560 DOI: 10.3928/01913913-20170907-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/07/2017] [Indexed: 11/20/2022]
Abstract
Although there are reports of iatrogenic Horner syndrome in the adult population, pediatric cases are rare. The current report presents a case of acquired Horner syndrome that occurred after an epidural catheter was placed for pain control. Horner syndrome completely resolved after removing the catheter and no imaging or further work-up was necessary. [J Pediatr Ophthalmol Strabismus. 2018;55:e1-e3.].
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Spors B, Seemann J, Homer N, Fay A. Lymphatic malformation with acquired Horner syndrome in an infant. J Neurointerv Surg 2018; 10:e2. [PMID: 29326377 DOI: 10.1136/neurintsurg-2017-013315.rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 11/03/2022]
Abstract
An infant presented with right upper eyelid ptosis and was subsequently diagnosed with acquired Horner syndrome. Further evaluation revealed a right-sided cervicothoracic lymphatic malformation. At 13 weeks of age, the child underwent percutaneous intracystic sclerotherapy with a mixture of sodium tetradecyl sulphate and ethanol. Twenty-one weeks after initial treatment, ophthalmic examination showed complete resolution of the blepharoptosis and pupillary miosis. Percutaneous sclerotherapy not only effectively treated the space-occupying lymphatic malformation but also reversed the Horner syndrome that was presumably induced by neural tension (more likely) or compression.
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Affiliation(s)
- Birgit Spors
- Department of Pediatric Radiology, Klinik für Strahlenheilkunde, Charite Hospital, Berlin, Germany
| | - Joerg Seemann
- Clinic for Radiology and Neurosurgery, Klinikum Barnim GmbH, Werner Forssmann Krankenhaus, Eberswalde, Brandenburg, Germany
| | - Natalie Homer
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Aaron Fay
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Center for Vascular Malformation, Werner-Forssmann Krankenhaus, Eberswalde, Germany
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Long-Term Follow-Up in Children with Anisocoria: Cocaine Test Results and Patient Outcome. J Ophthalmol 2017; 2017:7575040. [PMID: 29348932 PMCID: PMC5733942 DOI: 10.1155/2017/7575040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/07/2017] [Indexed: 11/25/2022] Open
Abstract
Background Evaluation of anisocoria including pharmacological testing for Horner's syndrome in the pediatric population is challenging in view of potential serious underlying disease. We describe cocaine test results, outcome of systemic investigation, and long-term follow-up in children with anisocoria. Methods Retrospective review of medical records and phone interview of consecutive pediatric patients (<18 years old) who underwent cocaine testing from August 2007 to July 2015 at a tertiary referral centre. Results A total of 35 patients were included with a positive, negative, or inconclusive cocaine test in 12/35, 19/35, and 4/35, respectively. Systemic investigation was performed in 11 of the patients with a positive and in 2 of the patients with an inconclusive cocaine test result. Mediastinal Hodgkin lymphoma was found in one patient with an inconclusive cocaine test result. Two other cases were presumably related to birth trauma and surgical trauma. None of the other children further developed any pathology during the follow-up period of 34.8 months (range 0–106.6). Conclusions In most children with anisocoria and a positive cocaine test result, systemic investigation did not reveal any underlying etiology. The only malignant disease was diagnosed in a patient with a suspicion of Horner's syndrome but with an inconclusive cocaine test result in our cohort.
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Usefulness of cocaine drops in investigating infant anisocoria. Eur J Paediatr Neurol 2017; 21:852-857. [PMID: 28807373 DOI: 10.1016/j.ejpn.2017.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 07/27/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Whereas apraclonidine has eclipsed cocaine test in the exploration of unilateral miosis in adults, its use in infants is avoided because of the risk of central nervous system depression. This chart review evaluates the usefulness of cocaine drops in infants. METHODS Infants under the age of one referred for unilateral miosis between November 1, 2009 and November 1, 2015, were reviewed. Patients underwent the following protocol: (1) in case of isolated miosis, cocaine test was performed. If the miotic pupil did not dilate, imaging was performed. Dilation in both eyes led to simple clinical follow-up. (2) In case of miosis associated with ptosis or iris heterochromia, imaging of the brain, neck and chest was directly performed. RESULTS Twenty-six children were included. Twenty-two presented an isolated miosis; three had ipsilateral ptosis, and one had no pupillary light reflex in the miotic eye. Cocaine tests performed in the 22 patients led to imaging in four, which was always normal. No side effect of the test was noticed. Imaging found one neuroblastoma and one intraorbital hemolymphangioma in two patients presenting miosis plus another sign. Imaging was avoided for 18 patients thanks to negative cocaine test. DISCUSSION Urgent imaging is mandatory in infants presenting with miosis associated with other localizing sign on the sympathetic nerve pathway (Horner syndrome). Since the uselessness of complementary investigations in isolated infantile miosis cannot be proven so far, cocaine test remains the gold standard, as it is safe, cheaper and less stressful than systematic imaging.
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Spors B, Seemann J, Homer N, Fay A. Lymphatic malformation with acquired Horner syndrome in an infant. BMJ Case Rep 2017; 2017:bcr-2017-013315. [PMID: 29066632 DOI: 10.1136/bcr-2017-013315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An infantpresented with right upper eyelid ptosis and was subsequently diagnosed with acquired Horner syndrome. Further evaluation revealed a right-sided cervicothoracic lymphatic malformation. At 13 weeks of age, the child underwent percutaneous intracystic sclerotherapy with a mixture of sodium tetradecyl sulphate and ethanol. Twenty-one weeks after initial treatment, ophthalmic examination showed complete resolution of the blepharoptosis and pupillary miosis. Percutaneous sclerotherapy not only effectively treated the space-occupying lymphatic malformation but also reversed the Horner syndrome that was presumably induced by neural tension (more likely) or compression.
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Affiliation(s)
- Birgit Spors
- Department of Pediatric Radiology, Klinik für Strahlenheilkunde, Charite Hospital, Berlin, Germany
| | - Joerg Seemann
- Clinic for Radiology and Neurosurgery, Klinikum Barnim GmbH, Werner Forssmann Krankenhaus, Eberswalde, Brandenburg, Germany
| | - Natalie Homer
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Aaron Fay
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Center for Vascular Malformation, Werner-Forssmann Krankenhaus, Eberswalde, Germany
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Zoulati M, Bakkali T, Aghoutane N, Bensaid B, Lyazidi Y, Ouharakat Y, Chtata H, Taberkant M. [Claude Bernard-Horner syndrome revealing spontaneous aneurysm of the vertebral artery]. JOURNAL DE MEDECINE VASCULAIRE 2017; 42:244-247. [PMID: 28705344 DOI: 10.1016/j.jdmv.2017.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/08/2017] [Indexed: 06/07/2023]
Abstract
False aneurysms of the extracranial vertebral artery (FAVA) are rare because of the path of the artery at the level of the transverse holes. They can be secondary to penetrating cervical trauma, spontaneous in the course of an angiopathy such as Ehlers-Danlos syndrome, or iatrogenic. We report the case of a 31-year-old woman who presented a syndrome of Claude Bernard-Horner related to a spontaneous FAVA. The angioscanner confirmed the diagnosis and the patient underwent successful surgical treatment of the false aneurysm with ligature of the vertebral artery. Outcome was favorable.
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Affiliation(s)
- M Zoulati
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc.
| | - T Bakkali
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - N Aghoutane
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - B Bensaid
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - Y Lyazidi
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - Y Ouharakat
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - H Chtata
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - M Taberkant
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
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Lipsett SC. Young Boy With Unilateral Facial Flushing. Ann Emerg Med 2017; 69:688-736. [DOI: 10.1016/j.annemergmed.2016.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Indexed: 11/16/2022]
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Maser T, Rich M, Hayes D, Zhao P, Nagulapally AB, Bond J, Saulnier Sholler G. Tolcapone induces oxidative stress leading to apoptosis and inhibition of tumor growth in Neuroblastoma. Cancer Med 2017; 6:1341-1352. [PMID: 28429453 PMCID: PMC5463066 DOI: 10.1002/cam4.1065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 02/13/2017] [Accepted: 03/04/2017] [Indexed: 01/11/2023] Open
Abstract
Catechol‐O‐methyltransferase (COMT) is an enzyme that inactivates dopamine and other catecholamines by O‐methylation. Tolcapone, a drug commonly used in the treatment of Parkinson's disease, is a potent inhibitor of COMT and previous studies indicate that Tolcapone increases the bioavailability of dopamine in cells. In this study, we demonstrate that Tolcapone kills neuroblastoma (NB) cells in preclinical models by inhibition of COMT. Treating four established NB cells lines (SMS‐KCNR, SH‐SY5Y, BE(2)‐C, CHLA‐90) and two primary NB cell lines with Tolcapone for 48 h decreased cell viability in a dose‐dependent manner, with IncuCyte imaging and Western blotting indicating that cell death was due to caspase‐3‐mediated apoptosis. Tolcapone also increased ROS while simultaneously decreasing ATP‐per‐cell in NB cells. Additionally, COMT was inhibited by siRNA in NB cells and showed similar increases in apoptotic markers compared to Tolcapone. In vivo xenograft models displayed inhibition of tumor growth and a significant decrease in time‐to‐event in mice treated with Tolcapone compared to untreated mice. These results indicate that Tolcapone is cytotoxic to neuroblastoma cells and invite further studies into Tolcapone as a promising novel therapy for the treatment of neuroblastoma.
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Affiliation(s)
- Tyler Maser
- Pediatric Oncology Translational Research Program, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Maria Rich
- Pediatric Oncology Translational Research Program, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - David Hayes
- Pediatric Oncology Translational Research Program, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Ping Zhao
- Pediatric Oncology Translational Research Program, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Abhinav B Nagulapally
- Pediatric Oncology Translational Research Program, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Jeffrey Bond
- Pediatric Oncology Translational Research Program, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Giselle Saulnier Sholler
- Pediatric Oncology Translational Research Program, Helen DeVos Children's Hospital, Grand Rapids, Michigan.,College of Human Medicine, Michigan State University, Grand Rapids, Michigan
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Latting MW, Huggins AB, Marx DP, Giacometti JN. Clinical Evaluation of Blepharoptosis: Distinguishing Age-Related Ptosis from Masquerade Conditions. Semin Plast Surg 2017; 31:5-16. [PMID: 28255284 DOI: 10.1055/s-0037-1598188] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Aponeurotic ptosis accounts for the majority of acquired ptosis encountered in clinical practice. Other types of ptosis include traumatic, mechanical, neurogenic, and myogenic. In addition to true ptosis, some patients present with pseudoptosis caused by globe dystopia, globe asymmetry, ocular misalignment, or retraction of the contralateral lid. It is particularly important for the clinician to rule out neurologic causes of ptosis such as dysfunction of the third cranial nerve, Horner's syndrome, and myasthenia gravis, as these conditions can be associated with significant systemic morbidity and mortality. A thorough history and physical examination is necessary to evaluate each patient presenting with a complaint of ptosis. Correctly identifying the cause of the patient's complaint allows the ptosis surgeon to plan for appropriate surgical repair when indicated and to defer surgery when observation or additional clinical evaluation is warranted.
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Affiliation(s)
- Michelle W Latting
- Wills Eye Hospital, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alison B Huggins
- Wills Eye Hospital, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Douglas P Marx
- Division of Oculoplastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
| | - Joseph N Giacometti
- Department of Oculoplastic and Orbital Surgery, Wills Eye Hospital, Philadelphia, Pennsylvania; Morgenstern Center for Orbital and Facial Plastic Surgery, Wayne, Pennsylvania
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Horner Syndrome Secondary to Thyroid Surgery. Case Rep Endocrinol 2017; 2017:1689039. [PMID: 28133554 PMCID: PMC5241455 DOI: 10.1155/2017/1689039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/21/2016] [Indexed: 11/18/2022] Open
Abstract
Horner syndrome (HS), caused by an interruption in the oculosympathetic pathway, is characterised by myosis, ipsilateral blepharoptosis, enophthalmos, facial anhydrosis, and vascular dilation of the lateral part of the face. HS is a rare complication of thyroidectomy. A 15-year-old female patient presented with solitary solid and large nodule in the right thyroid lobe. Ultrasound-guided fine-needle aspiration was performed and the cytological examination results were undefined. The patient underwent a total thyroidectomy. On postoperative day 2, she developed right-sided myosis and upper eyelid ptosis. HS was diagnosed. Interestingly, the patient exhibited an incomplete clinical syndrome with the absence of vasomotor symptoms. We herein report a case of HS in a 15-year-old female patient after total thyroidectomy. The possible causes of HS were ischaemia-induced nerve damage and stretching of the cervical sympathetic chain by the retractor during thyroidectomy. Clinicians should be aware of the possibility of this rare but important surgical complication.
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Liu Z, Chen Y, Lin Z, Shi X. Ophthalmic clues to the endocrine disorders. J Endocrinol Invest 2017; 40:21-25. [PMID: 27568184 DOI: 10.1007/s40618-016-0532-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/12/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Eye is a vital sense organ and reflects the physical and mental wellbeing of a person. Detailed examination of the eye is an essential part in the clinical evaluation of patients with any systemic disorder. The interaction between ophthalmologists and endocrinologists is often limited to Graves' ophthalmopathy and diabetic retinopathy. However, there are many ophthalmic manifestations, which are characteristically seen in endocrine disorders. In this review, we shall discuss the ocular manifestations of the endocrine syndromes excluding the Graves' ophthalmopathy and diabetic retinopathy. METHODS We performed a PubMed search of articles published in English showing the ophthalmic features in the endocrine disorders. Relevant cited articles were also retrieved. RESULTS Most of the publications included in the review were case reports and review articles. Many endocrine disorders have characteristic manifestations pertaining to the various structures of the eye. The involvement is seen from the external structures of the eye to the inner most layers of the retina. Many ocular-endocrine syndromes also exist with characteristic clues to the clinical diagnosis. CONCLUSION The endocrinologists need to be aware of these ocular signs that help in the early diagnosis of the underlying disorder. A syndromic approach is essential in the diagnosis of endocrinopathy in patients presenting with ophthalmic features.
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Affiliation(s)
- Z Liu
- Department of Ophthalmology, Changchun University of Medicine, Changchun, 130000, Jilin, China
| | - Y Chen
- Department of Ophthalmology, Changchun University of Medicine, Changchun, 130000, Jilin, China
| | - Z Lin
- Department of Ophthalmology, Changchun University of Medicine, Changchun, 130000, Jilin, China
| | - X Shi
- Department of Ophthalmology, Changchun University of Medicine, Changchun, 130000, Jilin, China.
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Kalaskar RR, Kalaskar AR. Neuroblastoma in early childhood: A rare case report and review of literature. Contemp Clin Dent 2016; 7:401-4. [PMID: 27630510 PMCID: PMC5004559 DOI: 10.4103/0976-237x.188579] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Neuroblastoma is an extremely rare pediatric neoplasm whose prognosis becomes poor and poor as the age advances. It can be sporadic or nonfamilial in origin. It is primarily a tumor of abdominal origin from where it metastasis to lymph nodes, liver, intracranial and orbital sites, and central nervous system. There is no standard dental treatment protocol for the management of neuroblastoma due to its poor survival rate and rarity. However, dental treatment may follow the protocol of preventive and restorative. Surgicals should be performed under supervision as it may trigger metastasis. We report a rare case of neuroblastoma in a 3-year-old child presenting classical oral manifestations such as bilateral palatal swelling, rolled border ulcer on the posterior part of hard palate adjacent to primary molars, and bilateral proptosis.
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Affiliation(s)
- Ritesh R Kalaskar
- Department of Pedodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India
| | - Ashita R Kalaskar
- Department of Oral Diagnosis Medicine and Radiology, VSPM Dental College and Research Center, Nagpur, Maharashtra, India
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Strabologische und neuroophthalmologische Aspekte kindlicher Tumorerkrankungen. Ophthalmologe 2016; 113:557-69. [DOI: 10.1007/s00347-016-0289-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Suh SH, Suh DW, Benson C. The Degree of Anisocoria in Pediatric Patients With Horner Syndrome When Compared to Children Without Disease. J Pediatr Ophthalmol Strabismus 2016; 53:186-9. [PMID: 27224954 DOI: 10.3928/01913913-20160405-07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 12/22/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To study the magnitude of anisocoria in pediatric patients using the plusoptiX A08 (plusoptiX GmbH, Nuremberg, Germany) photoscreener as compared to a literature review of pediatric patients with known Horner syndrome to determine if anisocoria alone should raise suspicion for the diagnosis. METHODS The medical records of 592 consecutive patients, neonates to 9 years old, were collected and analyzed. All patients had complete ophthalmic examinations that included photoscreening with the plusoptiX A08. Data included age, pupil sizes, and anisocoria. A complete literature search of documented pupillary size in pediatric patients with the diagnosis of Horner syndrome was performed. This was then compared to the normative pediatric pupil data from the study. RESULTS Of the 592 children without Horner syndrome, 372 had an anisocoria of 0.1 to 0.5 mm (62.84%), 167 had an anisocoria of 0.6 to 1.2 mm (28.16%), and 21 had an anisocoria of 1.3 mm or greater (3.70%). There was no correlation between increasing age and severity of anisocoria (P = .55). For pediatric patients with a diagnosis of Horner syndrome, the average level of anisocoria was 1.37 mm in room light and 2 mm in darkness. In room light, three children had anisocoria of 0.1 to 0.5 mm (9.4%), 14 had anisocoria of 0.6 to 1.2 mm (43.8%), and 15 had anisocoria of 1.3 mm or greater (46.9%). In darkness, the level of anisocoria increased in 19 patients, causing the first category, 0.1 to 0.5 mm, to include 1 patient (3.1%), the second group to include 5 patients (15.6%), and the last group to include 26 patients (81.3%). Other associated signs/symptoms included ptosis (100%), heterochromia (28.1%), anhidrosis (9.4%), straight hair on affected/curly on unaffected side (9.4%), and neck mass (6.3%). In 37.5% of cases, imaging results were negative and no specific etiology was determined. CONCLUSIONS In a study of 592 children without Horner syndrome, the average pupillary size increased with age, but the degree of anisocoria remained stable with increasing age. Over half of the children studied had anisocoria up to 0.5 mm (62.84%), but rarely had anisocoria greater than 1.3 mm (3.70%). In children with a diagnosis of Horner syndrome, the majority had anisocoria greater than 1.3 mm, with the discrepancy in pupil size becoming more apparent in low levels of light intensity. Anisocoria greater than 1.3 mm is unlikely to be physiologic in a child; therefore, he or she should be carefully evaluated for other localizing signs, such as ptosis, anhidrosis, and neck mass. [J Pediatr Ophthalmol Strabismus. 2016;53(3):186-189.].
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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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Pardal Souto M, Alas Barbeito A, Taboada Perianes M. Síndrome de Horner congénito. An Pediatr (Barc) 2015; 82:e213-4. [DOI: 10.1016/j.anpedi.2014.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 10/16/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022] Open
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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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Gangaputra S, Babiuch A, Bradfield YS. Cervical lymphadenopathy secondary to rhabdomyosarcoma presenting as Horner syndrome in an infant. J AAPOS 2015; 19:194-6. [PMID: 25818281 DOI: 10.1016/j.jaapos.2014.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/03/2014] [Accepted: 11/13/2014] [Indexed: 12/20/2022]
Abstract
A 4-week-old boy with left ptosis, anisocoria, and a mass on his left hand was diagnosed with Horner syndrome. The diagnosis precipitated a work-up for a possible malignant etiology. Magnetic resonance imaging demonstrated enlarged left cervical and axillary lymph nodes. A biopsy of the hand lesion confirmed embryonal rhabdomyosarcoma, but a biopsy of the axillary lymph node was negative. Mechanical pressure by noncancerous enlarged lymph nodes is hypothesized to cause the Horner syndrome.
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Affiliation(s)
- Sapna Gangaputra
- Department of Pediatric Ophthalmology and Strabismus, University of Wisconsin-Madison, Madison, Wisconsin
| | - Allison Babiuch
- Department of Pediatric Ophthalmology and Strabismus, University of Wisconsin-Madison, Madison, Wisconsin
| | - Yasmin S Bradfield
- Department of Pediatric Ophthalmology and Strabismus, University of Wisconsin-Madison, Madison, Wisconsin.
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Chen Y, Morgan ML, Barros Palau AE, Yalamanchili S, Lee AG. Evaluation and neuroimaging of the Horner syndrome. Can J Ophthalmol 2015; 50:107-11. [DOI: 10.1016/j.jcjo.2014.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/06/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022]
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Cahill JA, Ross J. Eye on Children: Acute Work-up for Pediatric Horner's Syndrome. Case Presentation and Review of the Literature. J Emerg Med 2015; 48:58-62. [DOI: 10.1016/j.jemermed.2014.07.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/21/2014] [Accepted: 07/01/2014] [Indexed: 11/25/2022]
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