Learning objectives
To review differential diagnosis of acquired pediatric Horner's syndrome (APHS) as well as its physiopathology; to suggest imaging workup in this clinical context; to emphasize advantages and limitations of the available techniques of imaging.
We will illustrate 3 cases of neuroblastoma as an etiology of acquired Horner syndrome in infants.
In order to suggest a reasonable imaging guideline to rule out the rare but severe most causes of this entity in children,
this study intends to point out advantages and limitations of different imaging modalities,...
Background
Horner’s syndrome classically corresponds to the clinical triad ofmiosis,
mild upper eyelid ptosis,
facial anhidrosis and/ or hyperemia.
Iris heterochromia,
apparent enophthalmos,
conjunctival congestion and ocular defective accommodation may also be observed.
These symptoms are related to injury ofthe oculo-sympathetic chain,
wether the lesion is central,
pre- or post-ganglionicin location.
(fig 1).
In children,
the etiologies of Horner syndrome should besubdivided into acquired and congenital causes (tab.1),
latest ones diagnosed during the first 4 weeks of life.
Although benign processes are the commonest causes ofinterruption...
Imaging findings OR Procedure details
The following3 illustrative cases of neuroblastoma as a cause of pediatric Horner Syndrome were 2 boys and 1 girl,
of about 7 to 8 months of age.
Two of them were studied with X-ray,
CT,
MRI and bone/MIBG scans,
the third one did not get any CT imaging.
Discussion
Based on anatomic and physiopathology background,
we recommend the physician involved in inital clinical assessment of APHS to first request a Chest Xray (CXR) with frontal and lateral projections, thus at the time of the primary...
Conclusion
In absence of previous history of birth trauma or cervico-thoracic surgery,
acquired Horner syndrome in a child must be evaluated with neuroimaging in order to rule out underlying disease including rare but severe tumoral causes.
Acquired pediatric Horner’s syndrome could benefit from simple first line imaging including frontal and lateral XRays of the chest and MRI-MRA of the head,
neck and upper chest,
covering at least the regions extending from the orbital apices to the T3 vertebrae,
where central,
pre and post-ganglionic causes of this...
References
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Arch Ophtamol 2010-128(3) 324-329
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Neuroimaging strategies for three types of Horner syndrome with emphasis on anatomic location.
JH Lee & Al
AJR2007-188;W74-W81
Pediatric Horner Syndrome: Etiologies and roles of imaging and urine studies to detect neuroblastoma and other responsible mass lesions.
NH Mahoney & Al.
Am J Ophtalmol 2006-142;651-659
Pediatric...