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    Imaging for Horner syndrome: Balancing cost with diagnostic accuracy

    A three-step protocol appears similar, less expensive than previously reported protocols


    Making a recommendation

    Based on the study findings, Chen recommended performing a single contrast head and neck MRI to the level of T2 in the chest for Horner syndrome.

    “We no longer rely on pharmacologic localization before imaging and all patients received the same protocol,” she said.

    Furthermore, she pointed out that all 27 patients in her study were found to have an etiology and patients with a negative MRI did not develop a new etiology during the follow-up period for Horner syndrome.

    “Compared with other recommended protocols, ours was similar to or less expensive than the other protocols that we reviewed and was easier and simpler to order,” Chen concluded.

    In summary, that protocol involves three steps:

    ·      a clinical diagnosis of Horner syndrome,

    ·      pharmacologic confirmation  with no need for localization, and

    ·      a single contrast-enhanced brain MRI extending to the level of T2 in the chest.

    In an acute setting, CT of the head and neck is performed with CTA.

    Andrew G. Lee, MD, summarized Chen’s research.

    “Ms. Chen’s work on Horner syndrome supports our current clinical practice of performing a CT and CTA of the head and neck in the acute setting to exclude a carotid dissection and performing a single MRI and MRA of the head and neck down to the T2 level in the chest for chronic or subacute Horner syndrome cases,” said Dr. Lee, chairman of ophthalmology, Houston Methodist Hospital Blanton Eye Institute and professor of ophthalmology, neurology, and neurosurgery, Weill Cornell Medicine; clinical professor of ophthalmology, UTMB Galveston and UT MD Anderson Cancer Center, Houston; and adjunct professor of ophthalmology, Baylor College of Medicine, Houston, the University of Iowa Hospitals and Clinics, Iowa City, IA, and the University of Buffalo, The State University of New York.

    “We make the diagnosis of Horner syndrome clinically and do not currently use the hydroxyamphetamine drops to pharmacologically localize or direct our neuroimaging study to the pre- or post-ganglionic oculosympathetic pathway,” he said. “This is a change in our previous practice where pharmacologic testing, localization, and directed imaging were performed.”

    More: 10 things you may have missed at ARVO 2016


    Ying Chen, BS

    E: [email protected]


    Andrew G. Lee, MD

    E: [email protected]

    This article was adapted from Chen’s presentation at the 2015 meeting of the American Academy of Ophthalmology. Chen and Dr. Lee have no financial interest in the subject matter.

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