Pupil examination and evaluation of pupillary disorders

Wilhelm, Helmut

doi:10.3109/01658109409025818

Cited by 3 publications

(1 citation statement)

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“…Hydroxyamphetamine drops are no longer available in the United Kingdom, but pholedrine (Ankerpharm GmBH, Ankerwerk Rudolstadt, Germany) is structurally similar to hydroxyamphetamine and has been shown to be comparable in its effects. 7 The distribution of sweating in Homer's syndrome is valuable in localising the site of the lesion clinically.6 The anatomical pathways concerned with thermoregulatory facial sweating are well established.9 When the lesion is proximal to the bifurcation of the common carotid artery there is hemifacial anhidrosis on the affected side, and when the lesion is distal the loss of sweating is confined to the medial aspect of the forehead. In patients not showing anhidrosis or with only mild asymmetry there is no localisation value, and many of these will have central lesions.…”

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confidence: 99%

The "harlequin" sign and congenital Horner's syndrome.

Morrison

Bibby

Woodruff

1997

Journal of Neurology, Neurosurgery & Psychiatry

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When trying to establish the likely anatomical site (preganglionic or postganglionic) of a lesion causing congenital Horner's syndrome, the distribution of facial flushing (the "harlequin" sign), may be seen. In babies and young children, facial flushing is a relatively simple clinical sign to demonstrate, compared with facial sweating. In unilateral facial flushing the areas that do not flush are almost always identical to the anhidrotic areas. However, neither facial flushing nor testing the pupil reactions with pholedrine or hydroxyamphetamine can be relied on to predict the probable site of any lesion causing congenital Horner's syndrome. Two patients with congenital Horner's syndrome are presented which demonstrated the "harlequin" sign and in whom clinical examination and pharmacological testing gave conflicting evidence for localisation of the site of the causative lesion. The presentation of congenital Horner's syndrome should be investigated and include MRI or CT to exclude a serious underlying cause. (7 Neurol Neurosurg Psychiatry 1997;62:626-628)

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confidence: 99%