Ying Chen1, Michael L Morgan2, Angelina Espino Barros Palau2, Sushma Yalamanchili2, Andrew G Lee3. 1. Baylor College of Medicine, Houston. 2. Department of Ophthalmology, Houston Methodist Hospital. 3. Baylor College of Medicine, Houston; Department of Ophthalmology, Houston Methodist Hospital; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston; UTMB, Galveston; UT M.D. Anderson Cancer Center; Department of Ophthalmology, Baylor College of Medicine, Houston, Tex; The University of Iowa Hospitals and Clinics, Iowa City, Iowa. Electronic address: AGLee@HoustonMethodist.org.
Abstract
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.
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.