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Does Horner's syndrome in infancy require investigation?
N D George1, G Gonzalez, C S Hoyt
1Department of Pediatric Ophthalmology, UCSF, USA.
The British Journal of Ophthalmology
|April 16, 1998
Summary
Investigating isolated Horner's syndrome in infants is often unnecessary. Most cases have no identifiable cause, and routine imaging is not recommended for early-onset Horner's syndrome.
Area of Science:
- Pediatric Ophthalmology
- Neurology
- Oncology
Background:
- Horner's syndrome in infancy can be a sign of serious underlying pathology.
- Previous guidelines suggested extensive investigations for infantile Horner's syndrome.
Purpose of the Study:
- To determine the necessity of routine investigations for isolated Horner's syndrome presenting in the first year of life.
- To identify appropriate diagnostic pathways for infantile Horner's syndrome.
Main Methods:
- Retrospective review of 23 pediatric patients diagnosed with Horner's syndrome within their first year of life.
- Analysis of diagnostic investigations including urinary vanillylmandelic acid (VMA) levels and imaging (CT/MRI) of the chest and neck.
- Long-term follow-up of identified cases.
Main Results:
- No identifiable cause was found in 70% of patients.
- Birth trauma was the most common identified cause (4 patients).
- Diagnostic imaging revealed pathology in only 2 patients (ganglioneuroma, neuroblastoma); one additional patient had known abdominal neuroblastoma.
Conclusions:
- Routine diagnostic imaging for isolated infantile Horner's syndrome is not warranted.
- Clinical examination for masses and cranial nerve involvement is recommended.
- Urinary VMA testing and pediatrician follow-up are advised for potential neuroblastoma detection in isolated cases.