Evaluation of Horner Syndrome in the MRI Era

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Title Evaluation of Horner Syndrome in the MRI Era
Creator Ama Sadaka, MD, Samantha L. Schockman, MD, Karl C. Golnik, MD
Affiliation Department of Ophthalmology (AS, SS, KCG), University of Cincinnati College of Medicine, Cincinnati, Ohio Department of Ophthalmology (KCG), Cincinnati Eye Institute, Cincinnati, Ohio
Abstract To identify the etiologies of adult Horner syndrome (HS) in the MRI era using a targeted evaluation approach and to assess the value and yield of targeted imaging. A retrospective chart review was performed of 200 adult outpatients with HS, confirmed with cocaine eyedrop testing. Patients were divided into subgroups based on the presence or absence of symptoms and those who did or did not receive additional testing with hydroxyamphetamine drops. Imaging was obtained based on pharmacologic localization and/or clinical evaluation. The etiology of HS and the yield of imaging were determined in all subgroups. Imaging showed causative lesions in 24 of 179 (12.84%) imaged patients with HS, and 13 (69.0%) were determined "idiopathic." Of the patients who underwent testing with hydroxyamphetamine drops (132 patients), 86 had a postganglionic localization with an imaging yield of 8.1%, and 46 had preganglionic cause with an imaging yield of 21.7%. Fifty-three patients (26.5%) never noticed ptosis/anisocoria before examination, and the imaging yield in this subgroup was 2.8%. Eighteen of the 200 patients (9.0%) had serious pathology, including carotid artery dissection, brain, or neck mass, and 6 of these (31.6%) had acute symptoms and/or pain. HS is most often idiopathic with serious pathology being relatively infrequent. When determining etiology, the absence of symptoms is not predictive of the pathology. However, acute onset of symptoms and/or pain are possible indicators for serious pathology. Localizing the lesion using hydroxyamphetamine drops whenever obtainable and available is still an efficient way to target imaging evaluation.
Subject Adolescent; Adult; Older people; Older people, 80 and over; Diagnosis, Differential; Female; Horner Syndrome; Humans; Magnetic Resonance Imaging; Male; Middle Older people; Reproducibility of Results; Retrospective Studies; Young Adult
OCR Text Show
Date 2017-09
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, September 2017, Volume 37, Issue 3
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6vf16pk
Setname ehsl_novel_jno
ID 1374446
Reference URL https://collections.lib.utah.edu/ark:/87278/s6vf16pk
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