Clinical Presentations of Pediatric Horner Syndrome

Frankie K Smith,Geetanjali Rathore,Donny W Suh

doi:10.4236/ojoph.2017.71006

Frankie K Smith, Geetanjali Rathore + Show 1 more

Open Access

https://doi.org/10.4236/ojoph.2017.71006

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Abstract

Purpose: To understand the multiple signs of Horner syndrome and to recommend protocols for pediatricians to obtain an accurate diagnosis of Horner syndrome. Methods: The medical records of 17 pediatric patients with Horner syndrome, neonates to eighteen years of age, were collected and analyzed. Data recorded included age, presenting symptoms, other medical history, allergies, medications, pupil size, presence of anhidrosis, and presence of ptosis. From the available pupil sizes, average degree of anisocoria was calculated. Results: All 17 patients had other clinical findings of Horner syndrome in addition to anisocoria. On initial evaluation, 100% had ptosis and 25% had anhidrosis. Of the available pupil size data, the average level of anisocoria was 2.06 mm, with a standard deviation of 1.17 mm. Conclusion: Physicians are reminded to measure pupil size to determine the degree of anisocoria when present, as it may help distinguish benign conditions from underlying pathology. Educating pediatricians on measurement of anisocoria and additional signs of Horner syndrome will help with proper referral patterns.

Highlights

Anisocoria in children is often an alarming sign due to the potential life threatening etiologies
Knowing the classic Horner syndrome triad of ptosis, miosis, and anhidrosis, we found that in patients presenting with anisocoria, ptosis was present in 100% of the documented cases, and anhidrosis was present in 25%
All patients in our study diagnosed with Horner syndrome had findings other than anisocoria alone

Summary

Introduction

Anisocoria in children is often an alarming sign due to the potential life threatening etiologies. A neuro-ophthalmologic condition caused by a lesion in the oculo-sympathetic pathway, should be considered in these patients. The post-ganglionic fibers re-enter the skull, ascending within the adventitia of the internal carotid artery to innervate the dilator pupillae and the Mueller’s muscle, causing dilation of the pupil and elevating the eyelid. A lesion anywhere in the oculo-sympathetic pathway results in ipsilateral miosis and ptosis. The postganglionic fibers innervate the facial sweat glands, if the injury occurs along the path of the carotid, ipsilateral anhidrosis is seen [2]. Horner’s syndrome can be congenital, acquired from trauma/mass lesion or iatrogenic from surgical manipulation. Most newly-diagnosed cases require neuro-imaging, commonly MRI, unless there is evidence of obvious trauma, or if diagnosis occurs after a surgical procedure

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