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Neuroimaging experience in pediatric Horner syndrome

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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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Abbreviations

CT:

Computed tomography

CTA:

CT angiogram

MRI:

Magnetic resonance imaging

MRA:

MRI angiogram

ICU:

Intensive care unit

References

  1. Fulton JF (1929) Edward Selleck Hare (1812–1838) and the syndrome of paralysis of the cervical sympathetic. Proc R Soc Med 23:152–157

    PubMed Central  CAS  PubMed  Google Scholar 

  2. Smith SJ, Diehl N, Leavitt JA et al (2010) Incidence of pediatric Horner syndrome and the risk of neuroblastoma: a population-based study. Arch Ophthalmol 128:324–329

    Article  PubMed Central  PubMed  Google Scholar 

  3. George ND, Gonzalez G, Hoyt CS (1998) Does Horner’s syndrome in infancy require investigation? Br J Ophthalmol 82:51–54

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Mahoney NR, Liu GT, Menacker SJ et al (2006) Pediatric horner syndrome: etiologies and roles of imaging and urine studies to detect neuroblastoma and other responsible mass lesions. Am J Ophthalmol 142:651–659

    Article  PubMed  Google Scholar 

  5. Al-Moosa A, Eggenberger E (2011) Neuroimaging yield in isolated Horner syndrome. Curr Opin Ophthalmol 22:468–471, Review

    Article  PubMed  Google Scholar 

  6. Walton KA, Buono LM (2003) Horner syndrome. Curr Opin Ophthalmol 14:357–363, Review

    Article  PubMed  Google Scholar 

  7. Jeffery AR, Ellis FJ, Repka MX et al (1998) Pediatric Horner syndrome. J AAPOS 2:159–167

    Article  CAS  PubMed  Google Scholar 

  8. Singh RR, Thomas AA, Barry MC et al (2004) Traumatic pseudoaneurysm of the internal carotid artery presenting with oculosympathetic palsy. Ir J Med Sci 173:162–163

    Article  CAS  PubMed  Google Scholar 

  9. Starr BE, Shubert RA, Baumann B (2004) A child with isolated Horner’s syndrome after blunt neck trauma. J Emerg Med 26:425–427

    Article  PubMed  Google Scholar 

  10. Gupta M, Dinakaran S, Chan TK (2005) Congenital Horner syndrome and hemiplegia secondary to carotid dissection. J Pediatr Ophthalmol Strabismus 42:122–124

    PubMed  Google Scholar 

  11. Mihora LD, Jatla KK, Enzenauer RW (2006) Horner syndrome due to ectopic cervical thymus. J Pediatr Ophthalmol Strabismus 43:46–48

    PubMed  Google Scholar 

  12. Online Mendelian Inheritance in Man (OMIM). An online catalog of human genes and genetic disorders. Updated 30 Jan 2015. http://www.omim.org/entry/143000. Accessed 1 Feb 2015

  13. Barkovich AJ, Raybaud C (2012) Pediatric neuroimaging, 5th edn. Lippincott Williams & Wilkins, Philadelphia, p 690

    Google Scholar 

  14. Kansal A, Lahiri A, Nishikawa H (2006) Sympathetic paraganglioma presenting with Horner’s syndrome in a child. J Plast Reconstr Aesthet Surg 59:772–774

    Article  PubMed  Google Scholar 

  15. Challapalli A, Howell L, Farrier M et al (2007) Cervical paraganglioma – a case report and review of all cases reported to the Manchester Children’s Tumour Registry 1954–2004. Pediatr Blood Cancer 48:112–116

    Article  PubMed  Google Scholar 

  16. Cannady SB, Chung BJ, Hirose K et al (2006) Surgical management of cervical ganglioneuromas in children. Int J Pediatr Otorhinolaryngol 70:287–294

    Article  PubMed  Google Scholar 

  17. Yip D, Drachtman R, Amorosa L et al (2010) Papillary thyroid cancer presenting as Horner syndrome. Pediatr Blood Cancer 55:739–741

    Article  PubMed  Google Scholar 

  18. Moreno TA, El-Dairi MA, Cabrera MT (2012) Isolated Horner syndrome and syringomyelia in a child. J AAPOS 16:569–570

    Article  PubMed  Google Scholar 

  19. Mutalib M, Vandervelde C, Varghese A et al (2007) Horner’s syndrome secondary to asymptomatic pneumothorax in an adolescent. Eur J Pediatr 166:507–508

    Article  PubMed  Google Scholar 

  20. Bhaskar G, Lodha R, Kabra SK (2006) Unusual complications of empyema thoracis: diaphragmatic palsy and Horner’s syndrome. Indian J Pediatr 73:941–943

    Article  CAS  PubMed  Google Scholar 

  21. Fan X, Miles JH, Takahashi N et al (2009) Abnormal transient pupillary light reflex in individuals with autism spectrum disorders. J Autism Dev Disord 39:1499–1508

    Article  PubMed  Google Scholar 

  22. Martin TJ (2007) Horner’s syndrome, Pseudo-Horner’s syndrome, and simple anisocoria. Curr Neurol Neurosci Rep 7:397–406, Review

    Article  CAS  PubMed  Google Scholar 

  23. Reede DL, Garcon E, Smoker WR et al (2008) Horner’s syndrome: clinical and radiographic evaluation. Neuroimaging Clin N Am 18:369–385, xi

    Article  PubMed  Google Scholar 

  24. Almog Y, Gepstein R, Kesler A (2010) Diagnostic value of imaging in horner syndrome in adults. J Neuroophthalmol 30:7–11

    Article  PubMed  Google Scholar 

  25. Thompson HS (1977) Diagnosing Horner’s syndrome. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol 83:840–842

    CAS  PubMed  Google Scholar 

  26. Digre KB, Smoker WR, Johnston P et al (1992) Selective MR imaging approach for evaluation of patients with Horner’s syndrome. AJNR Am J Neuroradiol 13:223–227

    CAS  PubMed  Google Scholar 

  27. Chan CC, Paine M, O’Day J (2001) Carotid dissection: a common cause of Horner’s syndrome. Clin Experiment Ophthalmol 29:411–415

    Article  CAS  PubMed  Google Scholar 

  28. Fons C, Vasconcelos M, Vidal M et al (2009) Agenesis of internal carotid artery in a child with ipsilateral Horner’s syndrome. J Child Neurol 24:101–104

    Article  PubMed  Google Scholar 

  29. Pirouzian A, Holz HA, Ip KC et al (2010) Acquired infantile Horner syndrome and spontaneous internal carotid artery dissection: a case report and review of literature. J AAPOS 14:172–174, Review

    Article  PubMed  Google Scholar 

  30. Flaherty PM, Flynn JM (2011) Horner syndrome due to carotid dissection. J Emerg Med 41:43–46, Review

    Article  PubMed  Google Scholar 

  31. Stovner LJ, Kruszewski P, Shen JM (1993) Sinus arrhythmia and pupil size in Chiari I malformation: evidence of autonomic dysfunction. Funct Neurol 8:251–257

    CAS  PubMed  Google Scholar 

  32. Kerrison JB, Biousse V, Newman NJ (2000) Isolated Horner’s syndrome and syringomyelia. J Neurol Neurosurg Psychiatry 69:131–132

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Ruiz E, Resende LS, Gaiolla RD et al (2012) Post-ganglionic Horner’s syndrome: an unusual presentation of non-Hodgkin lymphoma. Case Rep Neurol 4:43–46

    Article  Google Scholar 

  34. Guccione P, Gagliardi MG, Bevilacqua M et al (1992) Cardiac catheterization through the internal jugular vein in pediatric patients. An alternative to the usual femoral vein access. Chest 101:1512–1514

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Boston University Medical Center, Boston University School of Medicine, 820 Harrison Ave., FGH Building, 3rd Floor, Boston, MA, 02118, USA

    Nadja Kadom

  2. Division of Pediatric Neurology, Departments of Pediatrics and Neurology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA

    N. Paul Rosman

  3. Department of Radiology and Diagnostic Imaging, Children’s National Medical Center, Washington, DC, USA

    Shams Jubouri, Anna Trofimova & Alexia M. Egloff

  4. National Eye Institute (NEI), Bethesda, MD, USA

    Wadih M. Zein

Authors
  1. Nadja Kadom
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  2. N. Paul Rosman
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  3. Shams Jubouri
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  4. Anna Trofimova
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  5. Alexia M. Egloff
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  6. Wadih M. Zein
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Correspondence to Nadja Kadom.

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Kadom, N., Rosman, N.P., Jubouri, S. et al. Neuroimaging experience in pediatric Horner syndrome. Pediatr Radiol 45, 1535–1543 (2015). https://doi.org/10.1007/s00247-015-3341-9

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  • DOI: https://doi.org/10.1007/s00247-015-3341-9

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