title: Treatment of Harlequin syndrome by costotransversectomy and sympathectomy: case report.
abstract: BACKGROUND
  Harlequin syndrome is a rare neurological condition involving various degrees of unilateral hyperhidrosis and erythema of the head and neck. We present a clinical presentation and description of curative therapy in a patient with a sudden onset of Harlequin syndrome following a thoracotomy.
  
  
  METHODS
  A 42-year-old female with a history of mastectomy for right-sided breast cancer subsequently had a left partial pneumonectomy for a metastasis. Postoperatively, she had onset of contralateral neck and facial flushing and sweating. Flushing was triggered by emotion and exercise, but also occurred spontaneously at random intervals. Magnetic resonance imaging of the brain, cervical spine, and thoracic spine were negative for pathology. Because of the patient's surgical history and negative workup, she was given a diagnosis of Harlequin syndrome. Surgical intervention consisted of a partial right T3 costotransversectomy with T2 sympathectomy. Postoperatively, the patient's symptoms of Harlequin syndrome resolved. The procedure was complicated by T1 radicular pain, which responded well to Gabapentin.
  
  
  CONCLUSIONS
  The diagnosis of Harlequin syndrome is relatively new, and the majority of the scientific literature is concerned with descriptive case presentations. We present a surgical technique for the treatment of Harlequin syndrome.
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Eric Anthony
authors.initials: EA
authors.lastname: Sribnick
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Boulis
mesh_terms: D000328:Adult; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000601:surgery*; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D005260:Female; D005483:Flushing / Q000175:diagnosis / Q000601:surgery*; D000077206:Gabapentin; D006801:Humans; D007007:Hypohidrosis / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology*; D013562:Sympathectomy / Q000009:adverse effects*; D013908:Thoracotomy / Q000009:adverse effects*; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin