DOES HORNERS-SYNDROME IN INFANCY REQUIRE INVESTIGATION

Aims-To evaluate whether isolated Horner's syndrome presenting in the first: year of life warrants investigation. Method-Retrospective revie w of 23 children presenting with Horner's syndrome in the first year o f life. Results-In 16 patients (70%) no cause was identified. Birth tr auma was the most common identifiable cause (four patients). Twenty on e children (91%) urinary vanillylmandelic acid (VMA) measured and 13 p atients (57%) under went either computed tomography or magnetic resona nce imaging of the chest and neck. These investigations revealed previ ously undisclosed pathology in only two-one ganglioneuroma of the left pulmonary apex and one cervical neuroblastoma. A further patient was known to have abdominal neuroblastoma before presenting with Horner's syndrome. There were no cases of Horner's syndrome occurring after car diothoracic surgery. Long term follow up of the patients (mean 9.3 yea rs) has not revealed further pathology. Conclusions-Routine diagnostic imaging of isolated Horner's syndrome in infancy is unnecessary. Infa nts should be examined for cervical or abdominal masses and involvemen t of other cranial nerves. If the Horner's syndrome is truly isolated then urinary VMA levels and follow up in conjunction with a paediatric ian should detect any cases associated with neuroblastoma. Further inv estigation is warranted if the Horner's syndrome is acquired or associ ated with other signs such as increasing heterochromia, a cervical mas s, or cranial nerve palsies.