title: Harlequin sign concomitant with Horner syndrome after anterior cervical discectomy: a case of intrusion into the cervical sympathetic system.
abstract: Harlequin syndrome is a rare autonomic disorder referring to the sudden development of flushing and sweating limited to one side of the face. Like Horner syndrome, associating miosis, ptosis, and anhidrosis, Harlequin syndrome is caused by disruption of the cervical sympathetic pathways. Authors of this report describe the case of a 55-year-old female who presented with both Harlequin sign and Horner syndrome immediately after anterior cervical discectomy (C6-7) with cage fusion and anterior spondylodesis. They discuss the pathophysiology underlying this striking phenomenon and the benign course of this condition. Familiarity with this unusual complication should be of particular interest for every specialist involved in cervical and thoracic surgery.
authors.affiliation: Spine Unit, Department of Orthopaedic Surgery; and.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Fringeli
authors.affiliation: Unit of Neurology, Department of Internal Medicine, Cantonal Hospital Fribourg, Switzerland.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Humm
authors.affiliation: Spine Unit, Department of Orthopaedic Surgery; and.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Ansorge
authors.affiliation: Spine Unit, Department of Orthopaedic Surgery; and.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Maestretti
mesh_terms: D001342:Autonomic Nervous System Diseases / Q000209:etiology* / Q000503:physiopathology; D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D005483:Flushing / Q000209:etiology* / Q000503:physiopathology; D006732:Horner Syndrome / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007007:Hypohidrosis / Q000209:etiology* / Q000503:physiopathology; D007405:Intervertebral Disc Displacement / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology; D011843:Radiculopathy / Q000503:physiopathology / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects
keywords: cervical spine surgery; facial anhidrosis; hemifacial flushing; sympathetic pathways