The sensitivity and specificity of 0.5% apraclonidine in the diagnosis of oculosympathetic paresis

Koç, Feray; Kavuncu, Sevim; Kansu, Tülay; Acaroğlu, Gölge; Firat, Esin

doi:10.1136/bjo.2005.074492

Cited by 81 publications

(50 citation statements)

References 17 publications

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“…The overall sensitivity of Apraclonidine is 87%, 11 which is comparable to cocaine testing with a positive test reported within 36 h of onset of symptoms. 12 However, the results are yet to be validated in a large study and there are several reports of false negative tests.…”

Section: Challenges Of Pharmacological Localisationmentioning

confidence: 54%

Adult Horner’s syndrome: a combined clinical, pharmacological, and imaging algorithm

Davagnanam

Fraser

Miszkiel

et al. 2013

Eye

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The diagnosis of Horner's syndrome (HS) can be difficult, as patients rarely present with the classic triad of ptosis, miosis, and anhydrosis. Frequently, there are no associated symptoms to help determine or localise the underlying pathology. The onset of anisocoria may also be uncertain, with many cases referred after incidental discovery on routine optometric assessment. Although the textbooks discuss the use of cocaine, apraclonidine, and hydroxyamphetamine to diagnose and localise HS, in addition to reported false positive and negative results, these pharmacological agents are rarely available during acute assessment or in general ophthalmic departments. Typically, a week is required between using cocaine or apraclonidine for diagnosis and localisation of HS with hydroxyamphetamine, leaving the clinician with the decision of which investigations to request and with what urgency. Modern imaging modalities have advanced significantly and become more readily available since many of the established management algorithms were written. We thus propose a practical and safe combined clinical and radiological diagnostic protocol for HS that can be applied in most clinical settings.

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Section: Challenges Of Pharmacological Localisationmentioning

confidence: 54%

Adult Horner’s syndrome: a combined clinical, pharmacological, and imaging algorithm

Davagnanam

Fraser

Miszkiel

et al. 2013

Eye

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“…One study calculated the sensitivity of apraclonidine compared with that of cocaine in the diagnosis of all forms of OSP as 91% (N=11), 12 while another reported a sensitivity of 100% (N=9). 13 More recently, apraclonidine testing for OSP was reported in 65 patients in whom the diagnosis had previously been confirmed with cocaine testing. Two false-negative results were recorded, while in 3 patients reversal of anisocoria only occurred under high illumination.…”

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confidence: 99%

Pharmacologic testing in Horner's syndrome – a new paradigm

Smit

2010

S Afr Med J

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“…3 The result is that with the administration of 1-2 drops of 0.5% apraclonidine, there is dilation of the miotic pupil due to denervation supersensitivity, and thus reversal of the anisocoria in patients with Horner syndrome such as was observed in this patient. 4 NMO, or Devic disease, is an inflammatory condition of the central nervous system (CNS) characterised by both myelitis and optic neuritis. Both main clinical manifestations may present concurrently or with a time interval between symptoms.…”

Section: Discussionmentioning

confidence: 99%

Horner Syndrome in a Case of Neuromyelitis Optica

Lovera¹,

Jay

Biller³

2014

Neuro-Ophthalmology

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A 58-year-old right-handed woman presented with neck pain and right hemibody decreased pain and temperature sensation. Over the next 3 days, she developed left ptosis and miosis. The Horner syndrome was confirmed with 0.5% apraclonidine and neuromyelitis optica immunoglobulin G antibody titres were positive. Magnetic resonance imaging of the cervical spine showed a longitudinally extensive intramedullary expansile lesion more prominent on the left, with post-contrast enhancement extending from C2 to C5, consistent with neuromyelitis optica. This patient was diagnosed with neuromyelitis optica with an associated left Horner syndrome.Keywords: Horner syndrome, neuromyelitis optica, NMO IgG antibody CASE REPORTA 58-year-old right-handed woman presented with neck pain and associated right hemibody decreased pain and temperature sensation. Symptoms began a few days previously with severe neck pain after waking from an afternoon rest, then progressive loss of temperature sensation to cold on her right hand, followed by her right leg. She had also been experiencing a burning sensation over her shoulders and clavicles. Three days later she developed left ptosis and miosis (Figure 1a and b). Medical history was notable for Graves disease treated with radioactive iodine ablation. She also had a prior history of migraine headaches with aura and restless legs syndrome. Medications were laevothyroxine and pramipexole.On initial examination, she had hypalgesia and thermohypaesthesia on the right arm and leg, with impaired dexterity and brisk muscle stretch reflexes on the left hemibody. After 3 days, she also developed left ptosis and miosis. Pupils measured 4 mm in the right eye and 2.5 mm in the left eye in the dark, becoming isocoric at 1.5 mm in light. The diagnosis of Horner syndrome was confirmed with the application of 0.5% apraclonidine drops, which brought about reversal of the anisocoria and elimination of the ptosis.Magnetic resonance imaging (MRI) of the cervical spine was remarkable for a longitudinally extensive intramedullary expansile lesion more prominent on the left, with post-contrast enhancement extending from C2 to C3 (Figure 2a and b). Extensive ancillary studies were performed, and neuromyelitis optica (NMO) immunoglobulin G (IgG) antibody titres (antibody to aquaporin-4) were elevated at 31.6 U/mL (reference: 53) as well as an increased IgG synthesis rate in the cerebrospinal fluid (CSF), and elevated anti-TPO (thyroid peroxidase) antibody at 25.7 IU/mL (reference: 59). CSF showed a lymphocytic pleocytosis with white blood cell count (WBC) 25/mL (reference: 58) of which 74% were lymphocytes, and elevated protein content at 84 mg/dL (reference: 545). Visual evoked potentials (VEPs) were abnormal with evidence of a mildly prolonged right P100 response. The remainder of ancillary studies were unremarkable.She was treated with a 5-day course of 1000 mg intravenous (IV) methylprednisolone daily, and

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The sensitivity and specificity of 0.5% apraclonidine in the diagnosis of oculosympathetic paresis

Cited by 81 publications

References 17 publications

Adult Horner’s syndrome: a combined clinical, pharmacological, and imaging algorithm

Adult Horner’s syndrome: a combined clinical, pharmacological, and imaging algorithm

Pharmacologic testing in Horner's syndrome – a new paradigm

Horner Syndrome in a Case of Neuromyelitis Optica

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