Abstract
Background
Ptosis and anisocoria in a child may be subtle indications of occult pathology, and
making the observation acutely in the emergency department (ED) is important in guiding
patient management and treatment. Emergency physicians must evaluate patients to exclude
serious or life-threatening emergencies and ensure correct disposition of patients.
Horner syndrome in children may be considered congenital or acquired and may be from
benign or malignant causes. When an isolated, acquired Horner syndrome is suspected
in a pediatric patient, physical examination of the neck and abdomen for masses, as
well as spot urine catecholamines, vanillylmandelic acid and homovanillic acid, and
varying degrees of imaging are recommended as part of the initial evaluation. These
evaluations may be performed in the ED or may require hospitalization, depending on
the suspected anatomical localization and diagnostic considerations.
Case Report
A 21-month-old, normally developed girl presented to the University Hospital ED with
a 2-h history of right-sided eyelid drooping in the setting of a febrile illness.
An eventual diagnosis of Horner syndrome from cervical lymph node compression was
made on the basis of history, examination, and imaging findings.
Why Should an Emergency Physician Be Aware of This?
ED evaluations of pediatric patients differ from adults. Evaluation and work-up of
Horner syndrome in children can be challenging and can require varying degrees of
assessment and evaluation, depending on the diagnostic considerations. This article
will address the common pathologies responsible for isolated pediatric Horner syndrome
and the recommended ED evaluation.
Keywords
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References
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- Acquired Horner’s syndrome: clinical review.Optometry. 2003; 74: 245-256
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Article info
Publication history
Published online: September 30, 2014
Accepted:
July 1,
2014
Received in revised form:
June 21,
2014
Received:
February 19,
2014
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
