Original articlePediatric Horner Syndrome: Etiologies and Roles of Imaging and Urine Studies to Detect Neuroblastoma and Other Responsible Mass Lesions
Section snippets
Patient ascertainment and clinical review
Approval from the Children’s Hospital of Philadelphia Institutional Review Board was obtained for this study. The Neuro-ophthalmologic examination records, imaging reports, and pertinent laboratory data were reviewed for all children with a diagnosis of Horner syndrome seen by the Children’s Hospital of Philadelphia Neuro-ophthalmology service from July 1993 through July 2005. For the purposes of this study, Horner syndrome was defined as unilateral miosis with or without ipsilateral ptosis and
Results
Fifty-seven pediatric patients fulfilled criteria for Horner syndrome between 1993 and 2005 and were entered for further review. One six-year-old patient with a positive cocaine test and signs of Horner syndrome noted in infant photos was lost to follow-up and was not included in this study. Patient characteristics are included in Table 2. One patient was diagnosed with bilateral oculosympathetic pareses.15 Half of the patients had no previously established or readily identifiable etiology at
Discussion
A striking number (6/18 [33%]) of children presenting with Horner syndrome without a known etiology, but who subsequently had a complete workup including urine screening and head, neck, and chest imaging were found to have a responsible mass. Of these six children, four had a neuroblastoma found on MRI imaging despite the absence of elevated urine catecholamines.
Nicholas R. Mahoney, MD, graduated from the University of Pennsylvania School of Medicine in May 2006. After completing his internship, he will be an ophthalmology resident at the Scheie Eye Institute, University of Pennsylvania 2007–2010.
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Nicholas R. Mahoney, MD, graduated from the University of Pennsylvania School of Medicine in May 2006. After completing his internship, he will be an ophthalmology resident at the Scheie Eye Institute, University of Pennsylvania 2007–2010.
Grant T. Liu, MD, is a Professor of Neurology and Ophthalmology at the University of Pennsylvania. He completed a residency at the Harvard-Longwood Neurology Program and a neuro-ophthalmology fellowship at the Bascom-Palmer Eye Institute. Although he sees both adult and children with neuro-ophthalmic problems, Dr Liu’s special interest is in pediatric neuro-ophthalmology.