Is Horner’s syndrome in childhood a diagnostic dilemma? A case report

Poster Details

First Author: A.Sampaio PORTUGAL

Co Author(s):    A. Toscano   A. Paix   M. Martins        

Abstract Details

Purpose:

Horner's syndrome consists in the classic triad of miosis, ptosis and ipsilateral facial anhidrosis, and results from injury of at least one of the three neurons in the oculosympathetic pathway. In childhood, the etiology of this syndrome may be congenital or acquired. The common congenital cases are birth trauma, neoplasms and carotid abnormalities. The acquired cases, can be neoplasmas, neuroblastoma is the most common neoplasm present with Horner“s syndrome, or sequelae of head, neck, and chest surgery, but also can be caused by infection. When no etiology is identified, the syndrome is considered idiopathic. The authors present the case of a male child, 5 years old, who was evaluated for anisocoria, heterochromia of the iris and mild ptosis since birth. There wasn“t history of birth trauma.

Setting:

Ophthalmologic examination showed anisocoria with miosis of the left eye more evident in scotopic conditions, mild ptosis and ipsilateral heterochromia of the iris, the left eye“s iris was less pigmented. Visual acuity of 10/10 . The remaining ophthalmic examination including cycloplegia, biomicroscopy and fundoscopy revealed no significant changes.

Methods:

Complementary diagnostic examinations performed, the imaging studies (CT and MRI) revealed an oval lesion in the left upper mediastinum with 8 cm in diameter. A biopsy guided by CT was performed, and histopathological diagnosis was compatible with ganglioneuroma. The study of vanillylmandelic acid in urine was normal, while the body scintigraphy with 123I-MIBG showed moderate uptake of the radiopharmaceutical by mediastinal mass, without evidence of metastases.

Results:

He underwent surgical intervention in Hospital Dona Estefania, with total resection of the tumor.

Conclusions:

We emphasize the importance of general physical examination, and imaging and laboratory research in cases of Horner“s syndrome in childhood, especially in the absence of a history of trauma at birth and / or surgical treatment, due to the frequent association with potentially serious pathology as seen in clinical case. FINANCIAL DISCLOSURE?: No