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J Neuroophthalmol. 2010 Mar;30(1):7-11. doi: 10.1097/WNO.0b013e3181ce1a12.

Diagnostic value of imaging in horner syndrome in adults.

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1
Department of Ophthalmology, Meir Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. shuky.almog@gmail.com

Abstract

BACKGROUND:

The yield of imaging in Horner syndrome has been explored only in children. This study evaluates the yield of imaging in adults.

METHODS:

This was a retrospective cohort study of 52 patients with Horner syndrome examined in 2 neuro-ophthalmology hospital clinics. Patients were divided into 3 groups according to the ability to determine the etiology at the time of the first neuro-ophthalmology consultation: group I, etiology of Horner syndrome known at the initial neuro-ophthalmologic examination; group II, etiology of Horner syndrome not known at the initial neuro-ophthalmologic examination, but sufficient information obtained to allow targeted imaging; and group III, etiology of Horner syndrome not known at the initial neuro-ophthalmologic examination, and sufficient information not obtained to allow targeted imaging. The yield of investigation and the frequency of the different etiologies were evaluated.

RESULTS:

In 32 (62%) patients, the etiology was already known at the initial neuro-ophthalmologic examination (group I). The most prevalent etiology was surgical trauma. In 11 (21%) patients, a targeted imaging workup was possible, revealing an etiology in 7 patients (group II). Carotid dissection and cavernous sinus mass were the most common etiologies. In 9 (17%) patients, a nontargeted imaging evaluation was necessary, revealing an etiology in only 1 patient, who had a previously undetected thyroid malignancy (group III).

CONCLUSIONS:

The etiology of Horner syndrome is usually known at the time of initial presentation to a neuro-ophthalmologist. When the etiology is not known and clinical information permits a targeted imaging evaluation, an etiology can usually be determined, most commonly a cervical carotid artery dissection or a cavernous sinus mass. When the etiology is not known and clinical information is insufficient to allow a targeted imaging evaluation, an etiology is rarely discovered. Even so, nontargeted imaging is warranted because life-threatening lesions, such as thyroid malignancies, may rarely be detected.

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PMID:
20182199
DOI:
10.1097/WNO.0b013e3181ce1a12
[Indexed for MEDLINE]
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