title: Unusual case of persistent Horner's syndrome following epidural anaesthesia and caesarean section.
abstract: This is a rare case of persistent Horner's syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) of head, neck, and chest were unremarkable. Medline search using terms Horner's, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles describing Horner's syndrome in obstetric epidural anesthesia, of which 11 were following Caesarean section. The increased incidence of Horner's syndrome in the setting of epidural anesthesia in pregnancy may be related to epidural venous engorgement and cephalic spread of the local anaesthetic, with disruption in the oculosympathetic pathway. It is important to include recent epidural anesthesia within the differential diagnosis of acute Horner's syndrome in a postpartum female. Rarely, the ptosis may be permanent and require surgical intervention.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Oculoplastics Service, University of Wisconsin-Madison, USA.
authors.forename: Shubhra
authors.initials: S
authors.lastname: Goel
authors.forename: Cat Nguyen
authors.initials: CN
authors.lastname: Burkat
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000009:adverse effects* / Q000379:methods; D002585:Cesarean Section / Q000009:adverse effects*; D003943:Diagnostic Techniques, Neurological; D005260:Female; D005500:Follow-Up Studies; D006732:Horner Syndrome / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D011247:Pregnancy; D013997:Time Factors