Likelihood of Diagnosing Neuroblastoma in Isolated Horner Syndrome

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Title Likelihood of Diagnosing Neuroblastoma in Isolated Horner Syndrome
Creator Avi Ben Shabat; Shifra Ash; Judith Luckman; Helen Toledano; Nitza Goldenberg-Cohen
Affiliation Department of Ophthalmology (NG-C), Bnai Zion Medical Center, Haifa, Israel; Krieger Eye Research Laboratory (NG-C), Felsenstein Medical Research Center, Beilinson Hospital, Petach Tikva, Israel; The Ruth and Bruce Rappaport Faculty of Medicine (NG-C), Technion, Haifa, Israel; Sackler Faculty of Medicine (ABS, HT, SA), Tel Aviv University, Tel Aviv, Israel; Department of Radiology (JL), Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Department of Pediatric Oncology (HT, SA), Schneider Children's Medical Center of Israel, Petach Tikva; Israel
Abstract Background: The need for an extensive evaluation for neuroblastoma in children with Horner syndrome is controversial. Methods: A retrospective study design was used. The cohort included 47 children with anisocoria who were diagnosed with Horner syndrome and 135 children with neuroblastoma evaluated at a pediatric medical center between 2007 and 2015. To detect neuroblastoma, patients with Horner syndrome underwent brain and cervical MRI, abdominal ultrasound, and/or measurement of urinary vanillylmandelic acid (VMA). The neuroblastoma group was evaluated for signs/symptoms of Horner syndrome at the time of diagnosis. Results: Seven patients with Horner syndrome were lost to follow-up, and the findings of the remaining 40 were categorized according to the age of the patient. Horner syndrome most frequently was idiopathic (58%), and in only 1 patient did the discovery of neuroblastoma precede the appearance of Horner syndrome. In the 21 patients aged 1-18 years, Horner syndrome was acquired in 15 patients and congenital in 6. The most common etiology was trauma (62%). Imaging was performed in 14 patients and VMA testing in 13. Neuroblastoma was diagnosed in 5 patients; in none was it related to Horner syndrome. In the 135 patients with neuroblastoma, most of the tumors were diagnosed at Stage 4 (60%) or Stage 3 (30%) with 53% originating in the abdomen. In one patient (0.74%) with signs/symptoms of Horner syndrome at diagnosis of neuroblastoma, the tumor had been identified prenatally and the diagnosis confirmed by imaging postnatally. Conclusions: The absence of occult neuroblastoma in children with Horner syndrome and of signs/symptoms of Horner syndrome in the children diagnosed with neuroblastoma suggests that Horner syndrome might not be as frequent a cause of neuroblastoma as previously thought. We recommend that full investigation for neuroblastoma be reserved for suspicious cases associated with additional systemic signs or symptoms.
Subject Adolescent; Child; Child, Preschool; Female; Horner Syndrome / complications; Humans; Infant; Magnetic Resonance Imaging; Male; Neuroblastoma / complications; Neuroblastoma / diagnostic imaging; Neuroblastoma / urine; Retrospective Studies; Ultrasonography; Vanilmandelic Acid / urine
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Date 2019-09
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, September 2019, Volume 39, Issue 3
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6k41j4z
Setname ehsl_novel_jno
ID 1595877
Reference URL https://collections.lib.utah.edu/ark:/87278/s6k41j4z
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