Evaluation and neuroimaging of the Horner syndrome

Objective To define the efficacy, safety, and cost-effectiveness of a single centre's approach to evaluating Horner syndrome (HS) including a simplified single neuroimaging protocol. Design Case series study. Participants Medical records of 34 patients diagnosed with HS at Houston Methodist Hospital (HMH) were reviewed after obtaining Institutional Review Board approval. Methods A retrospective chart review was performed for all patients presenting with the diagnosis of HS at the HMH from January 2010 to November 2013. All patients had diagnostic imaging with contrast-enhanced brain magnetic resonance imaging (MRI) extending to the T2 level in the chest. They had either documented causative diagnosis for HS or were "idiopathic." Efficacy and cost-effectiveness of the proposed neuroimaging technique were analyzed compared with other recommended protocols. Results We initially reviewed 34 charts with presumed diagnosis of HS; 27 charts were included in the analysis. The average age of patients was 46.6 years. Eleven patients (41%) had a final diagnosis of HS secondary to a proven cause, and 16 patients (59%) were diagnosed as "idiopathic." Ten patients (63%) in the idiopathic group had follow-up, and none of those with follow-up had an alternative cause. The estimated cost of our recommended MRI protocol was US$667.76 without magnetic resonance angiography (MRA) or US$1501.71 with MRA. Conclusions A single contrast-enhanced brain MRI extending to the T2 level in the chest is an effective and simple means of ruling out life-threatening and other causative factors of HS. Compared with previous imaging recommendations, this proposed protocol may be simpler for clinicians to use and more cost-effective.