Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
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Review Case Reports
Positive apraclonidine test 36 hours after acute onset of horner syndrome in dorsolateral pontomedullary stroke.
A 40-year-old man developed a Horner syndrome as part of a dorsolateral medullary brainstem infarction. Thirty-six hours after the onset of the stroke, topical instillation of 0.5% apraclonidine produced reversal of anisocoria. This is the first case in which apraclonidine testing has been applied to a patient with a Horner syndrome caused by a lesion in the first segment of the oculosympathetic pathway and the shortest reported interval between clinical manifestations of the lesion and apraclonidine-induced reversal of anisocoria. A review of all reported cases of apraclonidine testing in Horner syndrome suggests that this is a promising diagnostic adjunct that must be validated in larger studies.
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We propose that a simple but reasonable initial interpretation of brain and spinal cord MRI can be made by considering whether signal intensity is white or black or gray on precontrast T1-weighted and T2-weighted pulse sequences. We have formulated this task as a 2 x 2 table.