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J Neuroophthalmol. 2010 Mar;30(1):12-7. doi: 10.1097/WNO.0b013e3181b1b41f.

Positive apraclonidine test 36 hours after acute onset of horner syndrome in dorsolateral pontomedullary stroke.

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Department of Ophthalmology, Hôpital Delafontaine, Saint-Denis, France.


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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