Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Hookworm Horner’s Syndrome 727

Side Effects & Complications

■Mebendazole: rarely mild intestinal complaints

■Pyrantel pamoate: occasional mild intestinal complaints, headache,

dizziness

■Albendazole: occasional mild intestinal complaints

Contraindications: First trimester of pregnancy. If mild infection,

no treatment at any time; if severe, treat with pyrantel pamoate after

first trimester. Iron will correct anemia even if worms not treated.

Complications of treatment: None beyond side effects listed.

follow-up

Routine

■See that anemia and hypoproteinemia is corrected. No need to erad-

icate all worms, so follow-up stool examinations are optional.

complications and prognosis

■Prognosis good. Proper instruction in wearing shoes, care in han-

dling soil, and proper disposal of excrement will prevent new infec-

tion.

Horner’s Syndrome...................................

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Typically found incidentally

■Occasional pts note unequal pupils

■Ipsilateral small (meiotic) pupil & ptosis

■Normal pupillary response to light & accommodation

■Ipsilateral sweating impairment may be present depending on site

of lesion

tests

■Cocaine (4%) instillation dilates a normal pupil but has no effect on

pupil of Horner’s syndrome

differential diagnosis

■Physiologic anisocoria is not accompanied by ptosis or sweating

abnormality, and the pupil dilates in response to 4% cocaine

■Pupillary responses to light & accommodation distinguish other

causes of pupillary inequality