| False negative apraclonidine test in two patients with Horner syndrome. | |
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MedLine Citation:
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PMID: 18454417 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Because of denervation supersensitivity, a miotic pupil in a sympathetically-denervated eye dilates in response to a dilute or weak alpha-1-agonist drug. A reversal of anisocoria after topical apraclonidine is considered as a positive test result that diagnoses a unilateral Horner syndrome. HISTORY AND SIGNS: Two women aged 34 and 46 years with a cocaine-confirmed oculosympathetic defect (Horner syndrome) were tested with 1 % topical apraclonidine on separate days. THERAPY AND OUTCOME: In one patient, her miotic Horner pupil dilated marginally but not enough to reverse the baseline anisocoria. Additionally, the upper lid on the same side retracted. There was no discernable effect of apraclonidine on the normal, contralateral eye. In the second patient, there was no pupillary response to apraclonidine but there was resolution of her ptosis. CONCLUSIONS: Neither patient demonstrated a reversal of anisocoria, the current criterion for diagnosing a Horner syndrome using apraclonidine. Thus, these two patients with an established oculosympathetic defect were said to have a "negative test" for Horner syndrome. Yet both women showed subtle pupil and/or lid changes in response to apraclonidine that were consistent with sympathetic denervation supersensitivity. Reversal of anisocoria following topical apraclonidine does not occur in all patients with a unilateral oculosympathetic defect and more specific parameters for defining a positive test result might optimize apraclonidine's utility as a diagnostic test for Horner syndrome. |
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Authors:
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A Kawasaki; F-X Borruat |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Klinische Monatsblätter für Augenheilkunde Volume: 225 ISSN: 0023-2165 ISO Abbreviation: Klin Monbl Augenheilkd Publication Date: 2008 May |
Date Detail:
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Created Date: 2008-05-05 Completed Date: 2008-07-25 Revised Date: 2009-11-11 |
Medline Journal Info:
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Nlm Unique ID: 0014133 Medline TA: Klin Monbl Augenheilkd Country: Germany |
Other Details:
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Languages: eng Pagination: 520-2 Citation Subset: IM |
Affiliation:
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Department of Neuro-Ophthalmology, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland. aki.kawasaki@ophtal.vd.ch |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic alpha-Agonists
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diagnostic use Adult Clonidine / analogs & derivatives*, diagnostic use False Negative Reactions Female Horner Syndrome / diagnosis* Humans Middle Aged Pupil / drug effects |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic alpha-Agonists; 4205-90-7/Clonidine; 66711-21-5/apraclonidine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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