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ACR Appropriateness Criteria® Horner Syndrome.

, Prachi Dubey1, Nitesh Shekhrajka2

  • 1Houston Methodist Hospital, Houston, Texas.

Journal of the American College of Radiology : JACR
|November 5, 2025
PubMed
Summary
This summary is machine-generated.

Imaging guidelines for Horner syndrome, a condition affecting the oculosympathetic pathway, are presented. These evidence-based recommendations aid in diagnosing patients presenting with miosis, ptosis, and anhidrosis.

Keywords:
AUCAppropriate Use CriteriaAppropriateness CriteriaHorner syndromeacute onset Horner’schronic Horner syndromeoculosympathetic pathwaypainless Horner syndrometraumatic Horner syndrome

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Area of Science:

  • Neurology
  • Radiology
  • Ophthalmology

Background:

  • Horner syndrome involves abnormalities in the oculosympathetic pathway, typically presenting with ipsilateral miosis, ptosis, and anhidrosis.
  • Imaging this pathway is challenging due to its extensive course, the need for specific protocols, and diverse underlying pathologies.

Purpose of the Study:

  • To provide evidence-based workup guidelines for imaging the oculosympathetic pathway in Horner syndrome.
  • To categorize clinical features for targeted imaging recommendations, including acuity, pain, trauma history, and neurological signs.

Main Methods:

  • Utilizes the American College of Radiology Appropriateness Criteria framework.
  • Incorporates systematic analysis of peer-reviewed literature and expert consensus using methodologies like GRADE and the RAND/UCLA Appropriateness Method.
  • Focuses on clinical features such as onset, pain, trauma history, and neurological deficits to guide imaging choices.

Main Results:

  • Presents a structured approach to imaging based on clinical presentation.
  • Offers recommendations for appropriate imaging procedures for various clinical scenarios of Horner syndrome.
  • Highlights the importance of tailored protocols for effective diagnosis.

Conclusions:

  • Clinical features are crucial for developing appropriate imaging strategies for Horner syndrome.
  • These guidelines aim to optimize diagnostic accuracy and efficiency in evaluating the oculosympathetic pathway.
  • The recommendations support clinicians in selecting the most suitable imaging studies for suspected Horner syndrome.