School of Medicine and Health Sciences Poster Presentations

Title

Pediatric Horner Syndrome from an Otolaryngologic Perspective

Document Type

Poster

Abstract Category

Health Sciences

Keywords

Horner syndrome, Neuroblastoma, Thymus, Ptosis, Miosis

Publication Date

Spring 5-1-2019

Abstract

Horner Syndrome, is classically described as the clinical triad of miosis, ptosis, and anhidrosis. In pediatric patients the condition may be congenital in origin or arise from neoplastic, infectious or traumatic conditions, including operative causes. Because the neural pathways of Horner's syndrome involve the cervical region, pediatric otolaryngologists may be involved in the management of acquired causes. Understanding the neural pathways, the pathophysiology, variable presentation, and the diagnosis is important in the appropriate management, particularly in malignant conditions. The primary objective of this study was to identify atypical presentations of pediatric Horner syndrome to prevent misdiagnosis in outpatient otolaryngology clinic. This was a case report with retrospective chart review of pediatric patients diagnosed with ptosis, congenital or unspecified, miosis, and neuroblastoma. We present two patients with Horner syndrome with particular emphasis on pediatric otolaryngology management and evaluation. Case 1 is a 5-month-old female presenting first to ophthalmology with concern for left eye ptosis later found to have a Level II neck mass on MRI and subsequently referred to otolaryngology. An excisional biopsy preformed showed poorly differentiated neuroblastoma. Case 2 is a 9-year-old female presenting to ophthalmology clinic with pupillary asymmetry and positive cocaine test in the left eye. An MRI showed a left neck mass with concern for carotid body tumor versus ectopic thymic tissue. These two cases emphasize the high level of suspicion required in pediatric otolaryngologists in order to avoid missing malignant etiologies.

Open Access

1

Comments

Presented at Research Days 2019.

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Pediatric Horner Syndrome from an Otolaryngologic Perspective

Horner Syndrome, is classically described as the clinical triad of miosis, ptosis, and anhidrosis. In pediatric patients the condition may be congenital in origin or arise from neoplastic, infectious or traumatic conditions, including operative causes. Because the neural pathways of Horner's syndrome involve the cervical region, pediatric otolaryngologists may be involved in the management of acquired causes. Understanding the neural pathways, the pathophysiology, variable presentation, and the diagnosis is important in the appropriate management, particularly in malignant conditions. The primary objective of this study was to identify atypical presentations of pediatric Horner syndrome to prevent misdiagnosis in outpatient otolaryngology clinic. This was a case report with retrospective chart review of pediatric patients diagnosed with ptosis, congenital or unspecified, miosis, and neuroblastoma. We present two patients with Horner syndrome with particular emphasis on pediatric otolaryngology management and evaluation. Case 1 is a 5-month-old female presenting first to ophthalmology with concern for left eye ptosis later found to have a Level II neck mass on MRI and subsequently referred to otolaryngology. An excisional biopsy preformed showed poorly differentiated neuroblastoma. Case 2 is a 9-year-old female presenting to ophthalmology clinic with pupillary asymmetry and positive cocaine test in the left eye. An MRI showed a left neck mass with concern for carotid body tumor versus ectopic thymic tissue. These two cases emphasize the high level of suspicion required in pediatric otolaryngologists in order to avoid missing malignant etiologies.