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Pediatric Horner syndrome
A R Jeffery1, F J Ellis, M X Repka
1Department of Ophthalmology, University Hospitals of Cleveland/Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Ohio 44106, USA.
Insights
Pediatric Horner syndrome has congenital and acquired causes, with birth trauma being common in congenital cases. Acquired cases often indicate serious underlying conditions requiring thorough evaluation.
Area of Science:
- Ophthalmology
- Pediatrics
- Neurology
Background:
- Horner syndrome in children presents unique diagnostic challenges.
- Understanding the causes of pediatric Horner syndrome is crucial for appropriate management.
Purpose of the Study:
- To define the etiologies of Horner syndrome in the pediatric population.
- To differentiate causes between congenital and acquired pediatric Horner syndrome.
Main Methods:
- Retrospective review of medical records for pediatric Horner syndrome patients (< 18 years).
- Data collected from pediatric ophthalmology services at two major referral centers.
Main Results:
- Seventy-three pediatric Horner syndrome patients were identified.
- Congenital Horner syndrome (42%) linked to birth complications; acquired Horner syndrome (42% post-surgery, 15% without surgery) associated with serious conditions like neuroblastoma.
- Neuroblastoma and other serious conditions were identified in both congenital and acquired cases.
Conclusions:
- Birth trauma history may obviate extensive workup for congenital Horner syndrome.
- Acquired pediatric Horner syndrome necessitates comprehensive evaluation due to frequent links with severe underlying diseases.
- Diagnostic decisions for congenital Horner syndrome without clear birth history should consider neuroblastoma incidence and clinical findings.
Introduction:
The purpose of this study was to define the etiologies of Horner syndrome in the pediatric population.
Methods:
A retrospective review was performed of the medical records of all pediatric Horner syndrome patients (< 18 years old) examined by the pediatric ophthalmology services at two large referral centers.
Results:
Seventy-three pediatric Horner syndrome patients were identified. Of these, 31 (42%) were congenital, 11 (15%) were acquired without surgical intervention, and 31 (42%) were acquired after a surgical procedure of the thorax, neck, or central nervous system. Of the congenital Horner syndrome patients, a history of delivery with the use of forceps, vacuum extraction, shoulder dystocia, fetal rotation, or postterm delivery was elicited in 16 patients (53%). Concomitant brachial plexus injury was identified in only 3 patients. Two patients had congenital varicella syndrome and 1 patient was diagnosed with neuroblastoma. This patient had a palpable supraclavicular mass and stridor. Diagnosis of the patients with acquired Horner syndrome included neuroblastoma (2), trauma (1), rhabdomyosarcoma (1), brainstem vascular malformation (1), disseminated sclerosis (1), and not determined (5).
Conclusion:
In children with congenital Horner syndrome, a history of forceful manipulation of the infant during birth may reduce the need for extensive systemic evaluation. Without such history, a decision to proceed with further evaluation is made with consideration of the relative incidence of neuroblastoma by age and the physical findings. All acquired pediatric Horner syndrome patients without a known etiology require thorough evaluation because of the frequent association of serious underlying disease.