You are called to the emergency room to evaluate a patient who had a mild motor vehicle accident. Other than neck pain she has no complaints. Her pupils react symmetrically to light and the rest of the examination is normal except for what is shown in the photograph below.

TYK 6.8.19


 

14 comments

    1. True, there will not be immediate super sensitivity and we don’t know exactly how quickly it develops although some people think can within hours. So depending on how quickly this patient is evaluated, apraclonidine testing may not be positive. This is one reason cocaine drops are probably better than apraclonidine.

  1. Important topic, thank you! I was just wondering about the denervation hypersensitivity being present at exam – if the Horner’s is caused by dissection secondary to motor vehicle accident, is its onset not delayed by a few days for the denervation to occur?

  2. Thank you for a nice case. Iopidine would be expected to cause dilate in the Horner eye due to denervation hypersensitivity. How soon would that be expected to occur? She was evaluated immediately after the trauma so presumably within few hours?

  3. Does this phatmalogic test work immediately after the trauma? Is it considered as gold standard or equivalent?

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