Horner syndrome in a pediatric patient

Abstract

Introduction: Horner syndrome (HS) is a rare neurological disorder arising from disruption of the oculosympathetic pathway. Pediatric HS is uncommon and may be congenital, but underlying sinister causes need to be excluded.

Case presentation: An 18-week-old boy presented with right peri-orbital swelling, initially thought to be pre-septal cellulitis. Further ophthalmic review revealed a right-sided HS. Imaging identified a probable cervical neuroblastoma, leading to an urgent referral to oncology.

Conclusion: Early recognition of pediatric HS is crucial as it may signal underlying malignancies like neuroblastoma. Atypical presentations with sequential or intermittent symptoms make diagnosis challenging. Comprehensive imaging and multidisciplinary care ensure timely diagnosis and management.

Keywords: Horner syndrome; Neuroblastoma; Pediatric.

FIGURE 1

A comparison pre‐ and post‐presentation (A) two weeks prior to presentation, with no evidence of ptosis or anisocoria; (B) the day after presentation in the pediatric ophthalmology clinic, with right‐sided ptosis and miosis.

FIGURE 2

Sagittal (A) and coronal (B) magnetic resonance images demonstrating the site of the space‐occupying lesion at the level of T1/T2, within the superior mediastinum and lateral to the trachea.

FIGURE 3

Neck ultrasound demonstrating the soft tissue mass on the right‐side of the root of the neck, directly abutting the anterolateral aspect of the upper thoracic vertebrae, adjacent to the trachea and posterior to the right brachiocephalic artery. Heterogeneous in echotexture, with small focal echogenicity suggestive of calcification. The mass is vascular with irregular internal flow.