Imaging of Horner syndrome in pediatrics: association with neuroblastoma

Khalatbari, Hedieh; Ishak, Gisele E.

doi:10.1007/s00247-020-04796-w

Cited by 4 publications

(3 citation statements)

References 96 publications

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“…Post-thyroidectomy HS belongs to the larger group of pathological entities inducing HS in young patients. Generally, the most common pediatric causes of HS are neuroblastoma, and birth trauma; yet, one third of individuals will remain without an obvious cause (but meticulous investigations are required anyway) [ 152 , 153 , 154 , 155 ]. The pediatric approach depends on circumstances from congenital syndromes with severe neurological damage to spontaneous mild detection of an eyelid ptosis or anisocoria; for infant anisocoria the gold standard of investigations remains cocaine testing which is needed in association with neuroimaging evaluation [ 156 , 157 , 158 , 159 ].…”

Section: Discussionmentioning

confidence: 99%

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Cârșote

Nistor

Popa

et al. 2023

JCM

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Horner’s syndrome (HS), caused by lesions of the 3-neuron oculosympathetic nerve pathway (ONP), includes the triad: blepharoptosis, miosis and anhidrosis (ipsilateral with ONP damage). Thyroid–related HS represents an unusual entity underling thyroid nodules/goiter/cancer–HS (T-HS), and post-thyroidectomy HS (Tx-HS). We aim to overview Tx-HS. This is a narrative review. We revised PubMed published, full-length, English papers from inception to November 2022. Additionally, we introduced data on post-thyroidectomy lymphocele/chylous leakage (Tx-L), and introduced a new pediatric case with both Tx-HS and Tx-L. Tx-HS: the level of statistical evidence varies from isolated case reports, studies analyzing the large panel of post-thyroidectomy complications reporting HS among the rarest side effects (as opposite to hypocalcemia), or different series of patients with HS due to various disorders, including T-HS/Tx-HS. Tx-HS is related to benign or malignant thyroid conditions, regardless the type of surgery. A pre-operatory rate of T-HS of 0.14%; a post-operatory rate of Tx-HS between 0.03% and 5% (mostly, 0.2%) are identified; a possible higher risk on endoscopic rather than open procedure is described. Incomplete HS forms, and pediatric onset are identified, too; the earliest identification is after 2 h since intervention. A progressive remission is expected in most cases within the first 2–6 months to one year. The management is mostly conservative; some used glucocorticoids and neurotrophic agents. One major pitfall is an additional contributor factor like a local compression due to post-operatory collections (hematoma, cysts, fistula, Tx-L) and their correction improves the outcome. The prognostic probably depends on the severity of cervical sympathetic chain (CSC) lesions: indirect, mild injury due to local compressive masses, intra-operatory damage of CSC like ischemia and stretching of CSC by the retractor associate HS recovery, while CSC section is irreversible. Other iatrogenic contributors to HS are: intra-operatory manipulation of parathyroid glands, thyroid microwave/radiofrequency ablation, and high-intensity focused ultrasound, and percutaneous ethanol injection into thyroid nodules. Tx-L, rarely reported (mostly <0.5%, except for a ratio of 8.3% in one study), correlates with extended surgery, especially lateral/central neck dissection, and the presence of congenitally—aberrant lymphatic duct; it is, also, described after endoscopic procedures and chest-breast approach; it starts within days after surgery. Typically low-fat diet (even fasting and parental nutrition) and tube drainage are useful (as part of conservative management); some used octreotide, local sealing solutions like hypertonic glucose, Viscum album extract, n-Butyl-2-cyanoacrylate. Re-intervention is required in severe cases due to the risk of lymphorrhoea and chylothorax. Early identification of Tx-HS and Tx-L improves the outcome. Some iatrogenic complications are inevitable and a multifactorial model of prediction is still required, also taking into consideration standardized operatory procedures, skillful intra-operatory manipulation, and close post-operatory follow-up of the patients, especially during modern era when thyroid surgery registered a massive progress allowing an early discharge of the patients.

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Section: Discussionmentioning

confidence: 99%

Horner’s Syndrome and Lymphocele Following Thyroid Surgery

Cârșote

Nistor

Popa

et al. 2023

JCM

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“…Others advocate for extension to visualize the abdomen and/or pelvis as well. [8] Pharmacologic testing for Horner syndrome diagnosis is warranted in uncertain cases, for example, in patients with unilateral miosis without associated findings like ptosis or heterochromia. Such testing can differentiate a true Horner syndrome from pseudo-Horner syndrome due to benign physiologic anisocoria with mild eyelid asymmetry or aponeurotic ptosis.…”

Section: Discussionmentioning

confidence: 99%

“…7 It is important to acknowledge that there are no consensus guidelines for investigating an isolated pediatric Horner syndrome, but clinical judgment and examination should tailor the diagnostic evaluation. 7,8 For example, associated abducens palsy may aid in localizing pathology to the cavernous sinus. Similarly, pain and/or recent trauma might suggest carotid dissection, which necessitates vessel imaging.…”

Section: Discussionmentioning

confidence: 99%

Child Neurology: Horner Syndrome in an Otherwise Well-Appearing Infant

Silverman

Beres

2022

Neurology

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We report an exemplary case of acquired Horner syndrome secondary to neuroblastoma in infancy. The patient presented with ptosis, miosis, and heterochromia. In reviewing the patient's laboratory and imaging workup, we highlight key etiologic differences between the pediatric and adult populations. Other important teaching points included in the discussion are a review of sympathetic neuroanatomy and oculosympathetic paresis, the appropriate and evidence-based diagnostic workup in infants and children, and a review of pharmacologic testing using cocaine and apraclonidine drops.

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