Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Pediatric Radiology
Published in: Pediatric Radiology 2/2021

01-02-2021 | Brachial Plexus Palsy | Review

Imaging of Horner syndrome in pediatrics: association with neuroblastoma

Authors: Hedieh Khalatbari, Gisele E. Ishak

Published in: Pediatric Radiology | Issue 2/2021

Login to get access

Abstract

Neuroblastoma is the most common neoplasm associated with pediatric Horner syndrome. The laboratory and imaging evaluation of isolated pediatric Horner syndrome is controversial. We review the literature published in the last several decades and present the rationale for the imaging work-up in this patient cohort.
Appendix
Available only for authorised users
Literature
1.
Karemaker JM (2017) An introduction into autonomic nervous function. Physiol Meas 38:R89–R118PubMed
2.
3.
Gross JR, McClelland CM, Lee MS (2016) An approach to anisocoria. Curr Opin Ophthalmol 27:486–492PubMed
4.
Martin TJ (2018) Horner syndrome: a clinical review. ACS Chem Neurosci 9:177–186PubMed
5.
Smith SJ, Diehl N, Leavitt JA, Mohney BG (2010) Incidence of pediatric Horner syndrome and the risk of neuroblastoma: a population-based study. Arch Ophthalmol 128:324–329PubMedPubMedCentral
6.
Abbas A, Manjila S, Singh M et al (2015) Johann Friedrich Horner and the repeated discovery of oculosympathoparesis: whose syndrome is it? Neurosurgery 77:486–491PubMed
7.
Wilhelm H (2011) Disorders of the pupil. Handb Clin Neurol 102:427–466PubMed
8.
Cohen LM, Elliott A, Freitag SK (2018) Acquired intermittent pediatric Horner syndrome due to neuroblastoma. Ophthalmic Plast Reconstr Surg 34:e38–e41PubMed
9.
Albert DM, Rubenstein RA, Scheie HG (1967) Tumor metastasis to the eye. II. Clinical study in infants and children. Am J Ophthalmol 63:727–732PubMed
10.
Jaffe N, Cassady R, Petersen R, Traggis D (1975) Heterochromia and Horner syndrome associated with cervical and mediastinal neuroblastoma. J Pediatr 87:75–77PubMed
11.
McRae D Jr, Shaw A (1979) Ganglioneuroma, heterochromia iridis, and Horner’s syndrome. J Pediatr Surg 14:612–614PubMed
12.
Sayed AK, Miller BA, Lack EE et al (1983) Heterochromia iridis and Horner's syndrome due to paravertebral neurilemmoma. J Surg Oncol 22:15–16PubMed
13.
O’Glasser AY, Milas KM (2016) Horner’s, heterochromia, and harlequins. J Gen Intern Med 31:137PubMed
14.
Morrison DA, Bibby K, Woodruff G (1997) The “harlequin” sign and congenital Horner’s syndrome. J Neurol Neurosurg Psychiatry 62:626–628PubMedPubMedCentral
15.
16.
Braungart S, Craigie RJ, Farrelly P, Losty PD (2019) Paediatric Horner’s syndrome: is investigation for underlying malignancy always required? Arch Dis Child 104:984–987PubMed
17.
Loewenfeld IE (1977) “Simple central” anisocoria: a common condition, seldom recognized. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol 83:832–839PubMed
18.
Lam BL, Thompson HS, Corbett JJ (1987) The prevalence of simple anisocoria. Am J Ophthalmol 104:69–73PubMed
19.
Reede DL, Garcon E, Smoker WRK, Kardon R (2008) Horner’s syndrome: clinical and radiographic evaluation. Neuroimaging Clin N Am 18:369–385, xi
20.
Barrea C, Vigouroux T, Karam J et al (2016) Horner syndrome in children: a clinical condition with serious underlying disease. Neuropediatrics 47:268–272PubMed
21.
Nagy AN, Hayman LA, Diaz-Marchan PJ, Lee AG (1997) Horner’s syndrome due to first-order neuron lesions of the oculosympathetic pathway. AJR Am J Roentgenol 169:581–584PubMed
22.
George A, Haydar AA, Adams WM (2008) Imaging of Horner’s syndrome. Clin Radiol 63:499–505PubMed
23.
Giles CL, Henderson JW (1958) Horner’s syndrome: an analysis of 216 cases. Am J Ophthalmol 46:289–296PubMed
24.
George ND, Gonzalez G, Hoyt CS (1998) Does Horner’s syndrome in infancy require investigation? Br J Ophthalmol 82:51–54PubMedPubMedCentral
25.
Ben Shabat A, Ash S, Luckman J et al (2019) Likelihood of diagnosing neuroblastoma in isolated Horner syndrome. J Neuroophthalmol 39:308–312PubMed
26.
Robertson WC, Pettigrew LC (2003) “Congenital” Horner’s syndrome and carotid dissection. J Neuroimaging 13:367–370PubMed
27.
Gupta M, Dinakaran S, Chan TK (2005) Congenital Horner syndrome and hemiplegia secondary to carotid dissection. J Pediatr Ophthalmol Strabismus 42:122–124PubMed
28.
Beckerman BL, Seaver R (1978) Congenital Horner’s syndrome and thoracic neuroblastoma. J Pediatr Ophthalmol Strabismus 15:24–25PubMed
29.
Musarella MA, Chan HS, DeBoer G, Gallie BL (1984) Ocular involvement in neuroblastoma: prognostic implications. Ophthalmology 91:936–940PubMed
30.
Jeffery AR, Ellis FJ, Repka MX, Buncic JR (1998) Pediatric Horner syndrome. J AAPOS 2:159–167PubMed
31.
Zafeiriou DI, Economou M, Koliouskas D et al (2006) Congenital Horner’s syndrome associated with cervical neuroblastoma. Eur J Paediatr Neurol 10:90–92PubMed
32.
Kadom N, Rosman NP, Jubouri S et al (2015) Neuroimaging experience in pediatric Horner syndrome. Pediatr Radiol 45:1535–1543PubMed
33.
Martin GC, Aymard P-A, Denier C et al (2017) Usefulness of cocaine drops in investigating infant anisocoria. Eur J Paediatr Neurol 21:852–857PubMed
34.
Ott C, Bobylev A, Holland-Cunz SG, Mayr J (2018) Unilateral straight hair-a symptom of acquired Horner’s syndrome in a neonate. European J Pediatr Surg Rep 6:e32–e36PubMedPubMedCentral
35.
Berroth ML, Morozova LV, Pollock JM (2020) Ectopic thymus as a cause of Horner’s syndrome. Radiol Case Rep 15:23–25PubMed
36.
37.
Deprez FC, Coulier J, Rommel D, Boschi A (2015) Congenital Horner syndrome with heterochromia iridis associated with ipsilateral internal carotid artery hypoplasia. J Clin Neurol 11:192–196PubMed
38.
Ryan F-H, Kline LB, Gomez C (2000) Congenital Horner’s syndrome resulting from agenesis of the internal carotid artery. Ophthalmology 107:185–188PubMed
39.
Dinc H, Alioglu Z, Erdol H, Ahmetoglu A (2002) Agenesis of the internal carotid artery associated with aortic arch anomaly in a patient with congenital Horner’s syndrome. AJNR Am J Neuroradiol 23:929–931PubMed
40.
Fons C, Vasconcelos M, Vidal M et al (2009) Agenesis of internal carotid artery in a child with ipsilateral Horner’s syndrome. J Child Neurol 24:101–104PubMed
41.
Cagan E, Sayin R, Dogan M et al (2010) Bilateral brachial plexus palsy and right Horner syndrome due to congenital cervicothoracal syringomyelia. Brain Dev 32:595–597
42.
Jurca MC, Kozma K, Petchesi CD et al (2017) Anatomic variants in Dandy-Walker complex. Romanian J Morphol Embryol 58:1051–1055
43.
Lee N, Nam S-O, Kim YM, Lee Y-J (2016) A neonate with Joubert syndrome presenting with symptoms of Horner syndrome. Korean J Pediatr 59:S32–S36PubMedPubMedCentral
44.
Puvanachandra N, Heran MK, Lyons CJ (2008) Morning glory disk anomaly with ipsilateral capillary hemangioma, agenesis of the internal carotid artery, and Horner syndrome: a variant of PHACES syndrome? J AAPOS 12:528–530PubMed
45.
Sankaran A, Bhardwaj P, Venkatramani H, Sabapathy SR (2018) Birth palsy in congenital varicella syndrome: a lesson in anatomy. Indian J Plast Surg 51:238–242PubMedPubMedCentral
46.
Naimer SA, Weinstein O, Rosenthal G (2000) Congenital Horner syndrome: a rare though significant complication of subclavian flap aortoplasty. J Thorac Cardiovasc Surg 120:419–421PubMed
47.
Woodruff G, Buncic JR, Morin JD (1988) Horner’s syndrome in children. J Pediatr Ophthalmol Strabismus 25:40–44PubMed
48.
Massimi L, Pepa Della GM, Tamburrini G, Di Rocco C (2011) Sudden onset of Chiari malformation type I in previously asymptomatic patients. J Neurosurg Pediatr 8:438–442PubMed
49.
Shewmon DA (1983) Unilateral straight hair in congenital Horner syndrome due to stellate ganglion tumor. Ann Neurol 13:345–346PubMed
50.
Gibbs J, Appleton RE, Martin J, Findlay G (1992) Congenital Horner syndrome associated with non-cervical neuroblastoma. Dev Med Child Neurol 34:642–644PubMed
51.
Moukheiber AK, Nicollas R, Roman S et al (2001) Primary pediatric neuroblastic tumors of the neck. Int J Pediatr Otorhinolaryngol 60:155–161PubMed
52.
Mahoney NR, Liu GT, Menacker SJ et al (2006) Pediatric horner syndrome: etiologies and roles of imaging and urine studies to detect neuroblastoma and other responsible mass lesions. Am J Ophthalmol 142:651–659PubMed
53.
Pollard ZF, Greenberg MF, Bordenca M, Lange J (2010) Atypical acquired pediatric Horner syndrome. Arch Ophthalmol 128:937–940
54.
Alvi S, Karadaghy O, Manalang M, Weatherly R (2017) Clinical manifestations of neuroblastoma with head and neck involvement in children. Int J Pediatr Otorhinolaryngol 97:157–162PubMed
55.
Sauer C, Levingohn MW (1976) Horner’s syndrome in childhood. Neurology 26:216–220PubMed
56.
Shikatani Y, Okazaki M, Sakao N et al (2015) A case of mediastinal granular cell tumor with Horner’s syndrome. Ann Thorac Cardiovasc Surg 21:567–569PubMedPubMedCentral
57.
Reid G, Purcell B, McNally O (2017) Metastatic testicular cancer, a Horner’s syndrome and brachial plexopathy. QJM 110:585–586PubMed
58.
Spors B, Seemann J, Homer N, Fay A (2017) Lymphatic malformation with acquired Horner syndrome in an infant. BMJ Case Rep 2017:bcr2017013315
59.
Watura K, Williams M, Bradley M (2015) Osteochondroma of the clavicle causing Horner’s syndrome. BMJ Case Rep 2015:bcr2015211705
60.
Spector RH (2008) Postganglionic horner syndrome in three patients with coincident middle ear infection. J Neuroophthalmol 28:182–185PubMed
61.
Safran MJ, Greenwald MJ, Rice HC, Polin KS (1990) Cervical spine dislocation presenting as an isolated Horner’s syndrome. Arch Ophthalmol 108:327–328PubMed
62.
Sohal APS, Dasarathi M, Gholkar A, McFarland R (2010) Unilateral Horner’s syndrome: an unusual childhood presentation. J Paediatr Child Health 46:695–701PubMed
63.
Pirouzian A, Holz HA, Ip KC, Sudesh R (2010) Acquired infantile Horner syndrome and spontaneous internal carotid artery dissection: a case report and review of literature. J AAPOS 14:172–174PubMed
64.
Bayhan GI, Karaca M, Yazici U, Tanir G (2010) A case of Horner’s syndrome after the surgical treatment of pulmonary hydatid cyst. Turkiye Parazitol Derg 34:196–199PubMed
65.
Kumar KP, Alam MS (2018) “Collateral damage:” Horner’s syndrome following excision of a cervical vagal schwannoma. Int J Appl Basic Med Res 8:190–192PubMedPubMedCentral
66.
van Santen HM, Aronson DC, Vulsma T et al (2004) Frequent adverse events after treatment for childhood-onset differentiated thyroid carcinoma: a single institute experience. Eur J Cancer 40:1743–1751PubMed
67.
Demiral M, Binay C, Simsek E, Ilhan H (2017) Horner syndrome secondary to thyroid surgery. Case Rep Endocrinol 2017:1689039PubMedPubMedCentral
68.
Giannikas C, Pomeranz HD, Smith LP, Fefer Z (2014) Horner syndrome after tonsillectomy: an anatomic perspective. Pediatr Neurol 51:417–420PubMed
69.
Urfalioglu S, Acipayam C, Guler M et al (2020) A rare catheter complication in a patient with neuroblastoma: Horner’s syndrome. Ophthalmic Plast Reconstr Surg 36:e43–e44PubMed
70.
Ghosh PS, Indulkar S (2012) Horner’s syndrome as complication of extracorporeal membrane oxygenation in a neonate. J Pediatr 160:349–349.e1PubMed
71.
Mutalib M, Vandervelde C, Varghese A et al (2007) Horner’s syndrome secondary to asymptomatic pneumothorax in an adolescent. Eur J Pediatr 166:507–508PubMed
72.
Folkert KN, de Beaufort H, Bauman NM (2020) Horner syndrome from a pediatric otolaryngology perspective. Ann Otol Rhinol Laryngol 129:191–194PubMed
73.
Cebeci D, Arhan E, Demir E et al (2018) Internal carotid artery dissection without intracranial infarct following a minor shoulder trauma: the second pediatric case and review of the literature. J Clin Neurosci 56:172–175PubMed
74.
75.
Weetman RM, Rider PS, Oei TO et al (1976) Effect of diet on urinary excretion of VMA, HVA, metanephrine, and total free catecholamine in normal preschool children. J Pediatr 88:46–50PubMed
76.
Sundell IB, Hallmans G, Nilsson TK, Nygren C (1989) Plasma glucose and insulin, urinary catecholamine and cortisol responses to test breakfasts with high or low fibre content: the importance of the previous diet. Ann Nutr Metab 33:333–340PubMed
77.
Tormo C, Lumbreras B, Santos A et al (2009) Strategies for improving the collection of 24-hour urine for analysis in the clinical laboratory: redesigned instructions, opinion surveys, and application of reference change value to micturition. Arch Pathol Lab Med 133:1954–1960PubMed
78.
Smith SJ, Diehl NN, Smith BD, Mohney BG (2010) Urine catecholamine levels as diagnostic markers for neuroblastoma in a defined population: implications for ophthalmic practice. Eye (Lond) 24:1792–1796
79.
Park JR, Eggert A, Caron H (2010) Neuroblastoma: biology, prognosis, and treatment. Hematol Oncol Clin North Am 24:65–86PubMed
80.
Laug WE, Siegel SE, Shaw KN et al (1978) Initial urinary catecholamine metabolite concentrations and prognosis in neuroblastoma. Pediatrics 62:77–83PubMed
81.
LaBrosse EH, Com-Nougue C, Zucker JM et al (1980) Urinary excretion of 3-methoxy-4-hydroxymandelic acid and 3-methoxy-4-hydroxyphenylacetic acid by 288 patients with neuroblastoma and related neural crest tumors. Cancer Res 40:1995–2001PubMed
82.
Park JR, Bagatell R, Cohn SL et al (2017) Revisions to the International Neuroblastoma Response Criteria: a consensus statement from the National Cancer Institute clinical trials planning meeting. J Clin Oncol 35:2580–2587
83.
El-Sayed AAF (2014) The prognostic value of concurrent Horner syndrome in extended Erb obstetric brachial plexus palsy. J Child Neurol 29:1356–1359PubMed
84.
Yoshida K, Kawabata H (2018) The prognostic value of concurrent Horner syndrome in surgical decision making at 3 months in total-type neonatal brachial plexus palsy. J Hand Surg Eur Vol 43:609–612PubMed
85.
Lequin MH, Peeters EAJ, Holscher HC et al (2004) Arterial infarction caused by carotid artery dissection in the neonate. Eur J Paediatr Neurol 8:155–160PubMed
86.
Moore SW, Satge D, Sasco AJ et al (2003) The epidemiology of neonatal tumours. Report of an international working group. Pediatr Surg Int 19:509–519PubMed
87.
Raciborska A, Bilska K, Weclawek-Tompol J et al (2016) Solid cancers in the premature and the newborn: report of three national referral centers. Pediatr Neonatol 57:295–301
88.
Desandes E, Guissou S, Ducassou S, Lacour B (2016) Neonatal solid tumors: incidence and survival in France. Pediatr Blood Cancer 63:1375–1380PubMed
89.
Chandrasekaran A (2018) Neonatal solid tumors. Pediatr Neonatol 59:65–70
90.
Vo KT, Matthay KK, Neuhaus J et al (2014) Clinical, biologic, and prognostic differences on the basis of primary tumor site in neuroblastoma: a report from the international neuroblastoma risk group project. J Clin Oncol 32:3169–3176PubMedPubMedCentral
91.
92.
Jnah AJ, Evans SK, Sewell K, Trembath A (2019) Neuroblastoma in a neonate: a case report. Neonatal Netw 38:341–347PubMed
93.
Dresler S, Harvey DG, Levisohn PM (1979) Retroperitoneal neuroblastoma widely metastatic to the central nervous system. Ann Neurol 5:196–198PubMed
94.
Lee SY, Chuang JH, Huang CB et al (1998) Congenital bilateral cystic neuroblastoma with liver metastases and massive intracystic haemorrhage. Br J Radiol 71:1205–1207PubMed
95.
96.
Schiavetti A, Foco M, Ingrosso A et al (2009) Congenital stage 1 neuroblastoma evolved into stage 4s. J Pediatr Hematol Oncol 31:59–60PubMed
97.
Tajiri T, Souzaki R, Kinoshita Y et al (2010) Concordance for neuroblastoma in monozygotic twins: case report and review of the literature. J Pediatr Surg 45:2312–2316PubMed
98.
Wader JV, Kumbhar SS, Shukla DB, Mavi S (2015) Disseminated congenital neuroblastoma — an autopsy case report. J Clin Diagn Res 9:ED03–ED04PubMedPubMedCentral
99.
Starchenko II, Dyachenko LV, Prylutskyi OK et al (2019) The observation of congenital retroperitoneal large size neuroblastoma. Exp Oncol 41:179–181PubMed
100.
Claros P, Bandos R, Gilea I et al (1999) Major congenital anomalies of the internal carotid artery: agenesis, aplasia and hypoplasia. Int J Pediatr Otorhinolaryngol 49:69–76PubMed
101.
Farhat W, Ahdab R, Hosseini H (2011) Congenital agenesis of internal carotid artery with ipsilateral Horner presenting as focal neurological symptoms. Vasc Health Risk Manag 7:37–40PubMedPubMedCentral
102.
Hageman G, Ippel PF, te Nijenhuis FC (1992) Autosomal dominant congenital Horner's syndrome in a Dutch family. J Neurol Neurosurg Psychiatry 55:28–30PubMedPubMedCentral
103.
Graef S, Irwin MS, Wan MJ (2020) Incidence and prognostic role of the ocular manifestations of neuroblastoma in children. Am J Ophthalmol 213:145–152PubMed
104.
Cohen MD, Auringer ST, Grosfeld JL et al (1993) Multifocal primary neuroblastoma. Pediatr Radiol 23:463–466PubMed
105.
Williams P, Wegner E, Ziegler DS (2014) Outcomes in multifocal neuroblastoma as part of the neurocristopathy syndrome. Pediatrics 134:e611–e616PubMed
Metadata
Title
Imaging of Horner syndrome in pediatrics: association with neuroblastoma
Authors
Hedieh Khalatbari
Gisele E. Ishak
Publication date
01-02-2021
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 2/2021
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-020-04796-w

Other articles of this Issue 2/2021

Pediatric Radiology 2/2021 Go to the issue

Original Article

Chest radiograph features of multisystem inflammatory syndrome in children (MIS-C) compared to pediatric COVID-19

Original Article

A noninvasive index to predict liver cirrhosis in biliary atresia

Original Article

Utility of sonography for identifying metastatic cervical adenopathy in children with differentiated thyroid carcinoma at presentation

Pictorial Essay

Virtual endoluminal aortic root views determined at coronary CT angiography — an important tool for improving anomalous coronary artery visualization and surgical planning

Original Article

Spinal ultrasound after failed landmarked-based lumbar puncture: a single institutional experience

Original Article

Overview of chest involvement at computed tomography in children with coronavirus disease 2019 (COVID-19)