title: Diagnostic value of imaging in horner syndrome in adults.
abstract: BACKGROUND
  The yield of imaging in Horner syndrome has been explored only in children. This study evaluates the yield of imaging in adults.
  
  
  METHODS
  This was a retrospective cohort study of 52 patients with Horner syndrome examined in 2 neuro-ophthalmology hospital clinics. Patients were divided into 3 groups according to the ability to determine the etiology at the time of the first neuro-ophthalmology consultation: group I, etiology of Horner syndrome known at the initial neuro-ophthalmologic examination; group II, etiology of Horner syndrome not known at the initial neuro-ophthalmologic examination, but sufficient information obtained to allow targeted imaging; and group III, etiology of Horner syndrome not known at the initial neuro-ophthalmologic examination, and sufficient information not obtained to allow targeted imaging. The yield of investigation and the frequency of the different etiologies were evaluated.
  
  
  RESULTS
  In 32 (62%) patients, the etiology was already known at the initial neuro-ophthalmologic examination (group I). The most prevalent etiology was surgical trauma. In 11 (21%) patients, a targeted imaging workup was possible, revealing an etiology in 7 patients (group II). Carotid dissection and cavernous sinus mass were the most common etiologies. In 9 (17%) patients, a nontargeted imaging evaluation was necessary, revealing an etiology in only 1 patient, who had a previously undetected thyroid malignancy (group III).
  
  
  CONCLUSIONS
  The etiology of Horner syndrome is usually known at the time of initial presentation to a neuro-ophthalmologist. When the etiology is not known and clinical information permits a targeted imaging evaluation, an etiology can usually be determined, most commonly a cervical carotid artery dissection or a cavernous sinus mass. When the etiology is not known and clinical information is insufficient to allow a targeted imaging evaluation, an etiology is rarely discovered. Even so, nontargeted imaging is warranted because life-threatening lesions, such as thyroid malignancies, may rarely be detected.
authors.affiliation: Department of Ophthalmology, Meir Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. shuky.almog@gmail.com
authors.forename: Yehoshua
authors.initials: Y
authors.lastname: Almog
authors.forename: Raz
authors.initials: R
authors.lastname: Gepstein
authors.forename: Anat
authors.initials: A
authors.lastname: Kesler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006732:Horner Syndrome / Q000145:classification* / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult