title: Harlequin syndrome--one face of many etiologies.
abstract: BACKGROUND
  A 55-year-old woman presented to hospital with a 3-month history of asymmetric facial flushing of the skin during exertion, and an 18-month history of left-sided ptosis and miosis. Detailed medical history analysis revealed that a palpable node measuring 0.8 x 1.2 x 1.2 cm (volume 1.1 ml) had been discovered 2 years previously, within the left lobe of an otherwise uncomplicated goiter that had been successfully managed for 20 years. Otherwise, the patient was healthy.
  
  
  METHODS
  Neurological examination, autonomic testing, duplex ultrasonography, scintigraphy and MRI.
  
  
  METHODS
  Harlequin syndrome following a lesion of the preganglionic sympathetic efferents, caused by neurovascular compression of the sympathetic chain between the stellate and superior cervical ganglion brought about by an elongated inferior thyroid artery.
  
  
  RESULTS
  Explanation of pathophysiology and benign nature of the condition.
authors.affiliation: Prince of Wales Medical Research Institute, University of New South Wales, Randwick, Sydney, NSW, Australia. g.wasner@neurologie.uni-kiel.de
authors.forename: Gunnar
authors.initials: G
authors.lastname: Wasner
authors.forename: Rainer
authors.initials: R
authors.lastname: Maag
authors.forename: Janne
authors.initials: J
authors.lastname: Ludwig
authors.forename: Andreas
authors.initials: A
authors.lastname: Binder
authors.forename: Jörn
authors.initials: J
authors.lastname: Schattschneider
authors.forename: Robert
authors.initials: R
authors.lastname: Stingele
authors.forename: Ralf
authors.initials: R
authors.lastname: Baron
mesh_terms: D001342:Autonomic Nervous System Diseases / Q000209:etiology*; D005260:Female; D005483:Flushing; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000150:complications; D009460:Neurologic Examination; D011877:Radionuclide Imaging; D017783:Superior Cervical Ganglion / Q000473:pathology*; D013546:Sweating / Q000502:physiology*; D013577:Syndrome; D018616:Ultrasonography, Doppler, Duplex