Coexisting harlequin and Horner syndromes after high thoracic paravertebral anaesthesia.
A patient undergoing left mastectomy and immediate latissimus dorsi breast reconstruction under combined paravertebral block and general anaesthesia developed transient, well-demarcated, right-sided hemifacial erythema and sweating, and left-sided Horner syndrome postoperatively. This "harlequin" appearance occurs because of a normal or excessive vasodilatory, thermoregulatory response to heat or emotion mediated by an intact sympathetic pathway on the erythematous side, together with relative pallor of the pharmacologically blocked side.
Burlacu
C L
CL
Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. crina@ireland.com
Buggy
D J
DJ
D000768:Anesthesia, General / Q000009:adverse effects; D004890:Erythema / Q000209:etiology*; D005148:Facial Dermatoses / Q000209:etiology*; D005260:Female; D005483:Flushing / Q000209:etiology*; D006732:Horner Syndrome / Q000209:etiology*; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects*; D011183:Postoperative Complications