Early Diagnosis of Horner Syndrome Using Topical Apraclonidine

Abstract

The diagnosis of Horner syndrome (HS) using apraclonidine eye drops is an alternative to the use of topical cocaine drops. A number of reports have described the efficacy of apraclonidine testing, but there is some debate over its sensitivity in the acute setting. We describe a patient with HS secondary to carotid dissection who had a positive response to apraclonidine 3 hours after the onset of symptoms. The case is made for a larger study of apraclonidine use to determine its true sensitivity and specificity, identify confounding factors, and redefine the criteria for positive testing.

Benign Epizodik Unilateral Midriazis (Olgu Sunumu)

“…kranial sinir felci, kapalı-açılı glokom ve travma gibi acil tedavi gerektiren, hayatı tehdit edici durumlara kadar değişiklik gösterebilir (6,7). Bu nedenle ayrıntılı öykü, tam bir fizik muayene ve gerekli olan olgularda görüntüleme yöntemlerinin kullanılması hayat kurtarıcı olabilir çünkü anizokorili vakalarda tedavi ve prognoz altta yatan hastalığa bağlıdır (8).…”

Neuro-ophthalmology Annual Review

“…Thus, further studies on apraclonidine testing in the acute setting may be necessary to define the sensitivity for the diagnosis of HS of less than 1 week's duration. 7 Kang et al 8 reported right sixth nerve palsy followed by ipsilateral HS suggesting the classic localization within the cavernous sinus (Parkinson sign). The MRI showed an enhancing thickening in both sphenoidal sinuses, bony destruction of the skull base, and extension into the right cavernous sinus with encasement of the right internal carotid artery (ICA).…”

Horner’s syndrome in patients admitted to the intensive care unit that have undergone central venous catheterization: a prospective study

“…It has been previously reported though that apraclonidine testing can become positive after sympathetic pathway trauma as early as 3 h after the insult. 15 It is also worth mentioning that it can be difficult to determine subtle miosis and ptosis in the critically ill patients with reduced levels of consciousness and we could have missed patients with subtle clinical findings in our screening process.…”