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Neuro-ophthalmology Questions of the Week: Anisocoria – Horner Syndrome & Cocaine

December 28, 2016 By

Questions:
1. How much anisocoria is necessary for the diagnosis of Horner’s syndrome to be made using cocaine drops?
a. 0.3 mm
b. 0.5 mm
c. 1.0 mm
d. 1.5 mm

2. What is the approximate mean odds ratio for the Cocaine pharmacologic test for Horner syndrome assuming a postcocaine anisocoria of at least 0.8mm?
a.   10:1
b.  100:1
c. 1,000:1
d. 10,000:1

3. Which of the following races may not dilate well with topical cocaine?
a. Asians
b. African Americans
c. Caucasians
d. Native Americans

4. Does the cocaine test for Horner syndrome result in a positive urinary test for cocaine?
a. Yes
b. No


Fig. 5.3. Right Horner’s Syndrome3

Neuro-ophthalmology Question of the Weeks: Anisocoria – Horner Syndrome Pharmacology

December 21, 2016 By

Question:
1.What is the effect of the following agents on the pupils in Horner Syndrome?
Cocaine
Hydroxyamphetamine
Apraclonidine

2. What is  the mechanism of action of each of these agent used to test Horner Syndrome?
Cocaine
Hydroxyamphetamine
Apraclonidine

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Neuro-ophthalmology Questions of the Week: Anisocoria – Horner Syndrome – Dilation Lag

December 14, 2016 By

Question:
How often is a dilation lag present in a patient with Horner Syndrome on the initial examination?
1. 100%
2.  85%
3.  70%
4.  50%

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Left-sided dilation lag in a 29-year-old man with Horner’s syndrome caused by a posterior mediastinal ganglioneuroma. Note that the degree of anisocoria is greater after 5 seconds in darkness (top) compared with findings after 15 seconds in darkness (bottom).  

Neuro-ophthalmology Question of the Week: Physiologic Anisocoria

December 7, 2016 By

Question: Which of the following are required for anisocoria to be physiologic?
1. Both pupils must react briskly to light.
2. There must be no dilation lag 5-15 seconds after room illumination is reduced to near darkness.
3. The patient must not be aware of the anisocoria.
4. The anisocoria is 1 mm or less.
5. The anisocoria must be present on different days.

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Neuro-ophthalmology Question of the Week: Anisocoria Greater in Darkness

November 30, 2016 By

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Question:
A patient presents with 1 mm of anisocoria with the left pupil being larger. Your examination of the pupils reveals: 1. each pupil reacted briskly to light, 2. the swinging flashlight test was normal, 3. the anisocoria was greater in a very dim room, and 4. at 15 seconds after dimming the room lights the right eye has not completed its dilation.

Which of the following possibilities should be considered?

  1. Adie’s pupil
  2. Horner’s syndrome
  3. Chemical blockade
  4. Iris sphincter damage

Neuro-ophthalmology Question of the Week: Anisocoria – One Pupil Sluggish to Light Stimulus

November 23, 2016 By

Question: A patient presents with anisocoria. Examination of the pupils reveals that the right pupil reacted briskly to light, whereas the larger left pupil was very sluggishly reactive.

Which of the following possibilities should be considered?

  1. Adie’s pupil
  2. 3rd nerve palsy
  3. Chemical blockade
  4. Iris sphincter damage

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Neuro-ophthalmology Question of the Week: Anisocoria Causes

November 16, 2016 By

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Question: Which of the following may cause anisocoria?

1. Normal physiology
2. A deficit of sympathetic innervation
3. A deficit of parasympathetic innervation
4. 3rd nerve paresis
5. Trauma
6. Congenital anomalies
7. Pharmacologic agents
8. Exposure to plant material

Neuro-ophthalmology Question of the Week: Emergency Department Evaluation of Anisocoria

November 9, 2016 By

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Question:

Describe the appropriate steps to take in the emergency department when evaluating  anisocoria.

Neuro-ophthalmology Question of the Week: Emergency Department Evaluation of Ptosis

November 2, 2016 By

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a. Photograph of the patient showing right partial ptosis. The left lid shows compensatory lid retraction because of equal innervation of the levator palpabrae superioris (Herring’s law).
b. Post tensilon test: Note the improvement in ptosis.

Question: Describe the appropriate steps to take  in the emergency department when evaluating  ptosis of recent onset.

Neuro-ophthalmology Question of the Week: Emergency Department Evaluation of Bilateral Disc Edema

October 26, 2016 By

Question: Describe the appropriate steps to take in the emergency department when evaluating bilaterally swollen discs.

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