A 32-YEAR-OLD white woman sought treatment for a 3-day history of episodic left pupillary distortion associated with blurred vision and abnormal periocular sensations. Attacks lasted between 3and 15 minutes, during which the pupil elongated at the 7-o'clock position (Figure 1). The patient had no headaches or other neurological symptoms or signs. Results of an ophthalmic examination performed between attacks were normal. A single similar episode had occurred 6 months earlier. Her medical history was unremarkable. Although the patient experienced no further attacks, findings from clinical examination, pharmacological testing, and videopupillography performed2 months later (Figure 2)demonstrated ipsilateral preganglionic Horner syndrome.
Photographs of the left eye taken at (A) the start of an episode showing a normal pupil contour, (B) 40 seconds later showing the pupil beginning to peak at the 7-o'clock position, (C) 3 minutes later showing maximal peaking, (D) 5 minutes later, and (E) 7 minutes later showing a return of the normal pupil contour.
Infrared videopupillographic recordings from left (OS) and right (OD) eyes during presentation of a light stimulus. Normal reflex constriction is followed by a redilatation lag in the left eye(arrow), indicating a sympathetic deficit (Horner syndrome). Pharmacological testing with 1% hydroxyamphetamine hydrobromide suggested a preganglionic lesion.
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