Usefulness of cocaine drops in investigating infant anisocoria

Martin, Gilles C.; Aymard, Pierre-Antoine; Dénier, Charlotte; Seghir, Caroline; Abitbol, Marc; Boddaert, Nathalie; Bremond-Gignac, Dominique; Robert, Matthieu P.

doi:10.1016/j.ejpn.2017.07.020

Cited by 12 publications

(13 citation statements)

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“…However, she did have new onset of anisocoria and ptosis suggestive of Horner's syndrome as well as concurrent weight loss which prompted further investigation and led to the diagnosis of mediastinal Hodgkin's disease. Similarly, in a recent case series of 26 infants with anisocoria, only a minority presented with an additional localizing sign such as ptosis and underlying disease was found exclusively in some of these cases [ 17 ].…”

Section: Discussionmentioning

confidence: 97%

“…Neuroblastoma is the most common occult malignancy to be associated with pediatric Horner's syndrome. The prevalence of underlying mass lesions in cases of Horner's syndrome without previously identified etiologies differs from 0% to up to 21% in different studies [ 7 – 10 , 16 , 17 ]. Musarella et al found Horner's syndrome in 14 of 405 (3.5%) patients with neuroblastoma, while it was the presenting sign in 9 (2.2%) of them [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Follow-Up in Children with Anisocoria: Cocaine Test Results and Patient Outcome

Fierz

Gerth‐Kahlert

2017

Journal of Ophthalmology

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Background Evaluation of anisocoria including pharmacological testing for Horner's syndrome in the pediatric population is challenging in view of potential serious underlying disease. We describe cocaine test results, outcome of systemic investigation, and long-term follow-up in children with anisocoria. Methods Retrospective review of medical records and phone interview of consecutive pediatric patients (<18 years old) who underwent cocaine testing from August 2007 to July 2015 at a tertiary referral centre. Results A total of 35 patients were included with a positive, negative, or inconclusive cocaine test in 12/35, 19/35, and 4/35, respectively. Systemic investigation was performed in 11 of the patients with a positive and in 2 of the patients with an inconclusive cocaine test result. Mediastinal Hodgkin lymphoma was found in one patient with an inconclusive cocaine test result. Two other cases were presumably related to birth trauma and surgical trauma. None of the other children further developed any pathology during the follow-up period of 34.8 months (range 0–106.6). Conclusions In most children with anisocoria and a positive cocaine test result, systemic investigation did not reveal any underlying etiology. The only malignant disease was diagnosed in a patient with a suspicion of Horner's syndrome but with an inconclusive cocaine test result in our cohort.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Long-Term Follow-Up in Children with Anisocoria: Cocaine Test Results and Patient Outcome

Fierz

Gerth‐Kahlert

2017

Journal of Ophthalmology

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“…20 In 2005, cocaine was found to be a weak dilator and therefore proved ineffective for diagnosing milder forms of Horner's syndrome (particularly partial Horner's syndrome). 7 Substitutions like apranoclonidine may not account for much of the observed cocaine decrease, as there is a low frequency of Horner's syndrome in the population. 7 Furthermore, there cannot be a complete substitution for cocaine in all cases by apranoclonidine.…”

Section: Discussionmentioning

confidence: 99%

“…7 Substitutions like apranoclonidine may not account for much of the observed cocaine decrease, as there is a low frequency of Horner's syndrome in the population. 7 Furthermore, there cannot be a complete substitution for cocaine in all cases by apranoclonidine. Infants are at risk for central nervous system depression with use of apranoclonidine, so cocaine eye drops are used instead for this population.…”

Section: Discussionmentioning

confidence: 99%

“…6 Cocaine can be employed for a variety of purposes in contemporary medicine, including as an anesthetic in various types of surgery as well as diagnosing specific diseases such as Horner syndrome. 7, 8 The administration of small doses of intranasal liquid cocaine (4% cocaine) is used by otorhinolaryngological surgeons for local anesthesia. Intranasal anesthetics, including cocaine, are absorbed systemically.…”

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confidence: 99%

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Decline, and Regional Disparities, in Medical Cocaine Usage in the United States

Armbuster

Banas

Feickert

et al. 2020

Preprint

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Purpose: Cocaine is a stimulant with a complex history that is used in otorhinolaryngological surgeries as a local anesthetic and vasodilator. There is extensive regulation in the United States for the storage and disposal of this Schedule II drug, potentially incentivizing health care professionals to avoid use. This descriptive study characterized medical cocaine use in the United States. Methods: Retail drug distribution from 2002-2017 in units of grams of weight was extracted for each state from the Drug Enforcement Administrations Automation of Reports and Consolidated Orders System database, which reports on medical, research, and analytical-chemistry use. The percent of buyers (hospitals, pharmacies, providers) was obtained. Use per state, corrected for population, was determined. Available data on cocaine use, as reported by the Medicare and Medicaid programs for 2013 to 2017, also were examined. Results: Medical cocaine use in the US, measured on the basis of mass, decreased 62.5% from 2002 to 2017. Hospitals accounted for 84.9% and practitioners for 9.9% of cocaine distribution in 2017. The number of pharmacies nationwide carrying cocaine dropped by 69.4% to 206. The percent of all US hospitals, practitioners, and pharmacies that carried cocaine in 2017 was 38.4%, 2.3%, and 0.3%, respectively. There was a seven-fold difference in distribution per state in 2002 (South Dakota = 76.1 mg/100 persons, Delaware = 10.1 mg/100 persons). Similarly, there was a ten-fold regional disparity observed for 2017. Relative to the average state, those reporting the highest values (Montana = 20.1 and North Dakota = 24.1 mg/100 persons), were significantly elevated. Cocaine use within the Medicare and Medicaid programs was negligible. Conclusion: Medical cocaine use across the United States exhibited a pronounced decline over a fifteen-year period. If this pattern continues, licit cocaine will soon become an obscure pharmacological relic of interest only to analytical chemists and medical historians.

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