Joshua Ong, Mariko Kurokawa, Sangeeta Khanna, Lindsey B De Lott, Ryo Kurokawa, Aseem Sharma
{"title":"Computed tomography-based investigation of degenerative neural cervicothoracic foraminal stenosis as a potential mechanism for Horner syndrome.","authors":"Joshua Ong, Mariko Kurokawa, Sangeeta Khanna, Lindsey B De Lott, Ryo Kurokawa, Aseem Sharma","doi":"10.3389/fopht.2024.1497845","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the presence and/or severity of cervicothoracic foraminal stenosis between the C7 and T3 segments could account for Horner syndrome, otherwise deemed to be idiopathic in nature.</p><p><strong>Methods: </strong>This study was an IRB-approved, retrospective study that included 28 patients [mean ± standard deviation (age: 54.5 ± 18.7 years)] with a confirmed diagnosis of Horner syndrome, absence of any identifiable cause, and availability of a neck CT/CT angiogram obtained within 6 months of the diagnosis. A neuroradiologist masked to the laterality of Horner syndrome reviewed the CT scans, documenting the presence/severity of foraminal stenosis at levels C7-T1, T1-2, and T2-3 on a 4-point Likert scale defined as follows: 0, none; 1, mild; 2, moderate; and 3, severe narrowing, with grades 1, 2, and 3 signifying <1/3rd, 1/3rd-2/3rd, and >2/3rd stenosis of the expected normal foraminal dimension.</p><p><strong>Results: </strong>Foraminal stenosis was present ipsilateral to the side of Horner syndrome in four (14.3%) patients and on the contralateral side in five (17.8%) patients. No significant difference in the extent of ipsilateral and contralateral foraminal stenosis was present at C7-T1 (<i>p</i> = 0.66), T1-2 (<i>p</i> = 0.32), or T2-3 (<i>p</i> = 0.75) levels. Mean ipsilateral (0.33 ± 1.0) and contralateral (0.33 ± 1.1) cumulative foraminal stenosis ddddscores were not significantly different (<i>p</i> = 1). Mean maximum foraminal stenosis scores ipsilateral (0.22 ± 0.59) and contralateral (0.30 ± 0.81) to the side of Horner syndrome were also comparable (<i>p</i> = 0.54).</p><p><strong>Conclusion: </strong>With the low prevalence of foraminal stenosis at C7-T3 segments and the equivalent prevalence and severity of foraminal stenosis ipsilateral and contralateral to the side of Horner syndrome, foraminal stenosis is unlikely to be a common causative mechanism for Horner syndrome.</p>","PeriodicalId":73096,"journal":{"name":"Frontiers in ophthalmology","volume":"4 ","pages":"1497845"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756520/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in ophthalmology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3389/fopht.2024.1497845","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: To investigate the presence and/or severity of cervicothoracic foraminal stenosis between the C7 and T3 segments could account for Horner syndrome, otherwise deemed to be idiopathic in nature.
Methods: This study was an IRB-approved, retrospective study that included 28 patients [mean ± standard deviation (age: 54.5 ± 18.7 years)] with a confirmed diagnosis of Horner syndrome, absence of any identifiable cause, and availability of a neck CT/CT angiogram obtained within 6 months of the diagnosis. A neuroradiologist masked to the laterality of Horner syndrome reviewed the CT scans, documenting the presence/severity of foraminal stenosis at levels C7-T1, T1-2, and T2-3 on a 4-point Likert scale defined as follows: 0, none; 1, mild; 2, moderate; and 3, severe narrowing, with grades 1, 2, and 3 signifying <1/3rd, 1/3rd-2/3rd, and >2/3rd stenosis of the expected normal foraminal dimension.
Results: Foraminal stenosis was present ipsilateral to the side of Horner syndrome in four (14.3%) patients and on the contralateral side in five (17.8%) patients. No significant difference in the extent of ipsilateral and contralateral foraminal stenosis was present at C7-T1 (p = 0.66), T1-2 (p = 0.32), or T2-3 (p = 0.75) levels. Mean ipsilateral (0.33 ± 1.0) and contralateral (0.33 ± 1.1) cumulative foraminal stenosis ddddscores were not significantly different (p = 1). Mean maximum foraminal stenosis scores ipsilateral (0.22 ± 0.59) and contralateral (0.30 ± 0.81) to the side of Horner syndrome were also comparable (p = 0.54).
Conclusion: With the low prevalence of foraminal stenosis at C7-T3 segments and the equivalent prevalence and severity of foraminal stenosis ipsilateral and contralateral to the side of Horner syndrome, foraminal stenosis is unlikely to be a common causative mechanism for Horner syndrome.