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Neuro-ophthalmology Question of the Week: Dilated pupil constricts to pilocarpine 0.125%

February 8, 2017 By

Question1:
A 35-year-old woman is evaluated for a 2-week history of photophobia and awareness that her right pupil is larger than the left. Examination shows absent right pupillary response to light stimulation of either eye. There is no diplopia and no evidence of extraocular muscle palsy. Upon local instillation of 0.125% pilocarpine, the larger pupil becomes smaller than the contralateral pupil.

Which of the following is the most likely location of the lesion?
1. ciliary ganglion
2. Edinger-Westphal nucleus
3. oculomotor nerve
4. optic chiasm
5. pretectal nucleus

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Neuro-ophthalmology Question of the Week: Anisocoria – Horner syndrome & Heterochromia Iridis

January 31, 2017 By

Question: Which of the following are correct?
1. A heterochromia iridis-associated acquired Horner syndrome is usually due to a lesion of the postganglionic neuron (third order).
2. Heterochromia iridis-associated acquired Horner syndrome only occurs in children?
3. In a patient with isolated heterochromia iridis-associated Horner syndrome, the lighter eye is the one with the oculosympathetic paresis.
4. When both Waardenburg and congenital Horner syndromes occur in the same individual the darker iris is the one with the oculosympathetic paresis.

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Neuro-ophthalmology Question of the Week: Horner Syndrome in Children

January 25, 2017 By

Question:
Which of the following are correct?
1. Heterochromia iridis in a child with Horner syndrome rules out neuroblastoma as a cause.
2. The most common cause of congenital Horner syndrome is a neuroblastoma.
3. Cervical neuroblastoma, a disease primarily of infants, has a favorable prognosis.
4. Cervical masses due to neuroblastoma, when felt, are commonly mistaken for infectious adenitis in children.
5. Cervical neuroblastoma in children almost always causes Horner syndrome.

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MRI showing a heterogeneously enhancing soft tissue lesion involving the root of neck

Neuro-ophthalmology Question of the Week: Anisocoria – Pseudo-Horner Syndrome

January 18, 2017 By

Question: Which of the following may reveal that the cause of anisocoria is not Horner syndrome?
1. Slit-lamp exam
2. The degree of anisocoria remains relatively constant in bright and dim illumination.
3. Repeat examinations of the patient on different days.
4. The absence of miosis on attempted near vision.
5. The failure of the pupil to constrict to light but does constrict with attempted near vision.

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Neuro-ophthalmology Questions of the Week: Horner Syndrome & Hydroxyamphetamine

January 11, 2017 By

Questions:
1. A positive Hydroxyamphetamine pharmacologic test for Horner Syndrome indicates a problem in which neuron of the sympathetic chain?
a. 1st order neuron (preganglionic)
b. 2nd order neuron (preganglionic)
c. 3rd order neuron (postganglionic)

2. When the difference in dilation is + or < 0.5 mm. how reliable is the Hydroxyamphetamine pharmacologic test for Horner Syndrome?
a. sensitivity of 100% and specificity of 100%
b. sensitivity of 93% and specificity of 83%
c. sensitivity of 83% and specificity of 73%
d.  sensitivity of 73% and specificity of 63

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Neuro-ophthalmology Questions of the Week: Horner Syndrome & Apraclonidine

January 4, 2017 By

Questions:
1. How reliable is the Apraclonidine pharmacologic test for
Horner Syndrome?
a. less reliable than cocaine
b. at least as reliable as cocaine
c. more reliable than cocaine

2. In children up to what age may Apraclonidine cause lethargy, bradycardia, or a reduced respiratory rate for up to 2 hours?
a. 3 months
b. 6 months
c. 1 year
d. 2 years

 

 

 

 

 

 

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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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