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181. Examination of the Cranial Nerves

and possibly a ptosis too. Horner's syndrome is a very good lateralising sign but a poor localising sign. The Argyll Robertson's pupil is small, does not react to light, but constricts on accommodation. If it is bilateral, the pupils are frequently unequal in size (anisocoria). Argyll Robertson's pupils are almost always related to neurosyphilis but similar pupils are occasionally found in diabetic neuropathy and in some hereditary neuropathies. The myotonic pupil (Holmes-Adie syndrome) reacts very slowly

2008 Mentor

182. Examination of the Eye

passing through the shaft of light) and for flare (slight cloudiness), suggestive of anterior . Pupils Look at their relative size - if you suspect anisocoria (different-sized pupils), stand back from the patient, darken the room and look through the ophthalmoscope. You can elicit the red reflex in both eyes and compare the size of these directly rather than shifting from one to the other close up. Look for change in shape (typically oval in acute angle-closure glaucoma, asymmetry in a penetrating

2008 Mentor

183. Diagnostic Ophthalmology (PubMed)

Canada Can Vet J 0004653 0008-5286 IM Animals Anisocoria diagnosis etiology pathology veterinary Diagnosis, Differential Dog Diseases diagnosis pathology Dogs Fatal Outcome Ophthalmoplegia complications diagnosis pathology veterinary Vocal Cord Paralysis diagnosis etiology pathology veterinary 2007 4 18 9 0 2007 5 8 9 0 2007 4 18 9 0 ppublish 17436913 PMC1800946 Semin Vet Med Surg (Small Anim). 1990 Feb;5(1):24-36 2191391 J Am Anim Hosp Assoc. 2002 Jan-Feb;38(1):55-9 11804316 J Am Vet Med Assoc. 2002

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2007 The Canadian Veterinary Journal

184. Effect of Brimonidine Tartrate Ophthalmic Solution 0.15% on Pupil Diameter in Normal Eyes

females of childbearing potential will have pregnancy test prior to participating in study) History of serious ocular, neurological, cardiovascular disease History of severe systemic disease History of arrhythmias or high blood pressure Patients currently taking any type of ocular or systemic medications except multivitamins. Patients with abnormal pupil shape, Addie's pupil, anisocoria, or abnormal pupil defect. Contacts and Locations Go to Information from the National Library of Medicine To learn

2006 Clinical Trials

185. The sensitivity and specificity of 0.5% apraclonidine in the diagnosis of oculosympathetic paresis. (PubMed)

hour later.Apraclonidine caused a mean dilation of 2.04 mm (range 1--4.5) (p<0.001) in the pupils with OSP and it caused pupillary constriction in the control eyes with a mean change of -0.14 mm (range 0.5 to --1) (p<0.05). It caused reversal of anisocoria in all HS cases. Its effects on both pupil diameters and upper lid levels differed significantly between the groups (p<0.001). The mean elevation in the upper lid was 1.75 mm (range 1--4) in the OSP group (p<0.001) and 0.61 mm (range 0--3

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2005 British Journal of Ophthalmology

186. Bilateral tonic pupils: Holmes Adie syndrome or generalised neuropathy? (PubMed)

of pupillotonia (small dark diameters, large light diameters, tonic near responses, attenuated light responses with light-near dissociation, and sector palsy). However, significant differences were found in the prevalence and magnitude of several pupil variables in the two patient groups. In particular, sector palsy and anisocoria exceeding 1 mm (in the light) were seen much more commonly in Holmes-Adie patients than patients with generalised neuropathy. The presence of both these pupil signs can be used

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2007 British Journal of Ophthalmology

187. Pupillary dilation lag is intermittently present in patients with a stable oculosympathetic defect (Horner syndrome). (PubMed)

Pupillary dilation lag is intermittently present in patients with a stable oculosympathetic defect (Horner syndrome). To examine the repeatability of detecting pupillary dilation lag in patients with Horner syndrome.Retrospective interventional study.Single referral institution.Fifteen patients with unilateral Horner syndrome and 16 subjects with physiologic anisocoria. Intervention procedure: Each subject underwent four pupillometric recordings in darkness. The asymmetry of pupillodilation (...) between the two eyes was calculated as the change in anisocoria between five seconds and 15 seconds in darkness. Pupillary dilation lag was considered present if the asymmetry measured > or =0.4 mm.Asymmetry of pupillodilation over four determinations.All subjects demonstrated fluctuations in the calculated asymmetry of pupillodilation. Eight patients (53%) with Horner syndrome demonstrated dilation lag on the first determination; 13 patients (87%) eventually demonstrated it during four

2007 American Journal of Ophthalmology

188. Efficacy of apraclonidine 0.5% in the diagnosis of Horner syndrome in pediatric patients under low or high illumination. (PubMed)

Efficacy of apraclonidine 0.5% in the diagnosis of Horner syndrome in pediatric patients under low or high illumination. To evaluate the efficacy and safety of apraclonidine 0.5% in the diagnosis of Horner syndrome in pediatric patients.Prospective, interventional case series.Ten pediatric patients with a diagnosis of Horner syndrome and 10 age-matched controls with physiologic anisocoria underwent pharmacological testing with apraclonidine. The difference between the pupil diameters of both (...) ). Three patients with Horner syndrome showed positive values (reversal of anisocoria) only under high ambient illumination, but not under low illumination. There was no statistical difference in the mean differences in pupil diameter before and after apraclonidine testing in the control group. Conjunctival hyperemia was noted in two patients with Horner syndrome and in three patients in the control group. No systemic adverse effects were noted during the examination or were reported by patients

2006 American Journal of Ophthalmology

189. Bilateral posterior dislocation of the crystalline lens after a head injury sustained during a seizure. (PubMed)

Bilateral posterior dislocation of the crystalline lens after a head injury sustained during a seizure. This article presents a case of bilateral posterior dislocations of the crystalline lens in a patient with epilepsy who presented with reduced vision and anisocoria 2 weeks after having sustained head injuries during a seizure. The possibility of lens dislocation was raised only at this time, and subsequently confirmed on computed tomography. Such patients may require prompt referral

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2007 Emergency Medicine Journal

190. Risk factors for intraoperative hypotension in traumatic intracranial hematoma. (PubMed)

concerning (1) age; (2) gender; (3) mechanism of injury; (4) Glasgow Coma Scale (GCS) on admission; (5) abnormality of the pupils (anisocoria or mydriasis); (6) mean arterial blood pressure; (7) heart rate; (8) time elapsed before craniotomy from injury; (9) initial brain CT scans; (10) duration of craniotomy; and (11) total infusion or urine volume until craniotomy were collected prospectively as IHT risk factors. Low GCS score (<5), tachycardia (heart rate >112min(-1)) and hypertension (mean blood

2004 Resuscitation

191. Computed tomographic angiography for the diagnosis of blunt carotid/vertebral artery injury: a note of caution. (PubMed)

parallel comparative study aims at validating this high accuracy and examining the rates of evaluability of CTA performed with a 16-detector scanner with image reconstruction by modern imaging software.Patients at risk for BCVI (facial/cervical-spinal fractures; unexplained neurologic deficit; anisocoria; lateral neck soft tissue injury; clinical suspicion) underwent both CTA (16-channel multidetector scanner) and DSA. Results of the 2 studies and the clinical course were prospectively recorded.During

2007 Annals of Surgery

192. Adverse effects of apraclonidine used in the diagnosis of Horner syndrome in infants. (PubMed)

Adverse effects of apraclonidine used in the diagnosis of Horner syndrome in infants. Apraclonidine, a selective alpha(2)-agonist, was developed to lower intraocular pressure and minimize the systemic side effects associated with the use of its parent drug, clonidine.(1) An investigation of the site of action of apraclonidine incidentally uncovered a reversal of anisocoria in patients with absent sympathetic innervation of one pupil (Horner syndrome) due to its alpha(1)-effect on a pupil

2007 JAAPOS - Journal of the American Association for Pediatric Ophthalmology and Strabismus

193. Pituitary carcinoma in an Airedale terrier (PubMed)

Pituitary carcinoma in an Airedale terrier A 6-year-old Airdale terrier showed behavioral changes for 1 mo, progressing to neurological signs that included proprioceptive deficits, circling, anisocoria, and head pressing. A large, invasive, pituitary carcinoma was diagnosed at postmortem.

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2003 The Canadian Veterinary Journal

194. Urgent surgical intervention in pediatric patients with Chiari malformation type I. Report of two cases. (PubMed)

became profoundly hypopneic with dysphagia and right hemiparesis over a less than 48-hour period. The second patient presented with a few days of worsening right hemiparesis, gait disturbance, and anisocoria. In addition to a CM-I, magnetic resonance imaging in the second patient revealed a holocord syrinx. Following urgent posterior fossa decompression, both patients rapidly improved in the 24 hours immediately following surgery and continued to improve in the subsequent weeks. Few reports detail

2007 Journal of Neurosurgery

195. Horner syndrome due to first rib fracture after major thoracic trauma. (PubMed)

be kept in mind in cases of first rib fractures. When head trauma is considered, as it can be mistaken with anisocoria, this knowledge may help the surgeon in differential diagnosis.

2005 Journal of Pediatric Surgery

196. Comparing efficacies of 0.5% apraclonidine with 4% cocaine in the diagnosis of horner syndrome in pediatric patients. (PubMed)

. The difference in the pupil diameters of each eye was recorded under dim light before and 1 h after 0.5% apraclonidine or 4% cocaine was instilled. Any adverse effects were noted during examination or reported by the patients' parents were recorded.The mean differences in pupil diameter before and after 4% cocaine testing were -2.08 and -2.97 mm, respectively (P = 0.0047). All patients had an anisocoria greater than 1 mm after 4% cocaine testing. The mean difference in pupil diameter before and after 0.5 (...) % apraclonidine was instilled were -2.04 and +1.08 mm, respectively (P = 0.005). All patients showed a reversal of anisocoria after 0.5% apraclonidine testing. Conjunctival hyperemia was noted in 2 patients, but systemic adverse effects were not noted during examination nor reported by the patients' parents.The application of 0.5% apraclonidine in pediatric patients is safe and effective in the diagnosis of Horner syndrome.

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2006 Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics Controlled trial quality: uncertain

197. Dissociated unilateral convergence paralysis in a patient with thalamotectal haemorrhage. (PubMed)

Dissociated unilateral convergence paralysis in a patient with thalamotectal haemorrhage. A 47 year old male was admitted in a comatose state. CT scan showed a haemorrhage in the right pulvinar thalamus descending into the right part of the lamina quadrigemina. He presented with anisocoria, prompt bilateral pupillary light reaction, and unilateral convergence paralysis contralateral to the lesion in combination with upward gaze palsy. During an observation period of two months, the convergence

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1992 Journal of neurology, neurosurgery, and psychiatry

198. A case of Brown-Sequard syndrome with associated Horner's syndrome after blunt injury to the cervical spine (PubMed)

. Neurological examination however, revealed anisocoria, his left pupil being smaller than his right, and a Brown-Sequard syndrome, with a sensory level at C6. Immobilisation was maintained and he was transferred to the regional neurosurgical centre where magnetic resonance imaging revealed a contusion of the left half of the spinal cord adjacent to the 6th cervical vertebrae. Computed tomography revealed no bony injury but spinal column instability was demonstrated after flexion-extension spinal views

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2001 Emergency Medicine Journal : EMJ

199. Naloxone eye drops reverse the miosis in runners--implications for an endogenous opiate test. (PubMed)

that exercise generated endogenous opiates cause pupillary miosis, and that ophthalmic naloxone to one eye can block this exercise pupillary effect resulting in ipsilateral mydriasis. Suggestions are given for a simple "Naloxone Anisocoria Test" for the presence or absence of elevated endogenous opiates.

1983 Canadian journal of applied sport sciences. Journal canadien des sciences appliquées au sport

200. Isolated unilateral neurogenic blepharoptosis secondary to eyelid trauma. (PubMed)

unilateral upper eyelid ptosis with no levator palpebrae superioris function, consistent with loss of innervation. Additional findings included minimal eyelid ecchymosis, eyelid edema, and subconjunctival hemorrhage in two cases. The remainder of the examinations was unremarkable with full ocular motility and no anisocoria. Without treatment, within 2 weeks, all three patients recovered completely with normal symmetric lid height and levator function.Isolated neurogenic blepharoptosis may result from

2002 American Journal of Ophthalmology

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