Coexisting harlequin and Horner syndromes after high thoracic paravertebral block

Harlequin Syndrome as a Complication of Epidural Anesthesia

“…18 Additionally, a patient's body position at the time of injection or infusion may play a role, particularly in the unilateral distribution. 12,14,16 In our case, normal results on the neurological examination suggested that acute stroke was not responsible for the signs and symptoms in question. Because of the normal results, computed tomography of the head was not deemed necessary.…”

“…Neuropraxia of the sympathetic innervation of the face after internal jugular catheterization has been implicated as a cause of transient harlequin syndrome. 11 Additionally, cases of harlequin syndrome associated with the administration of regional anesthetics, including extrapleural bupivacaine infusion, 10 high thoracic paravertebral anesthesia [12][13][14] ; and asymmetrical epidural anesthesia [15][16][17] have been reported.…”

“…6 The preganglionic fibers responsible for the innervation of the vasomotor reflexes of the face arise from the upper thoracic branches at the level of T2-T3, whereas occulomotor branches arise at T1. 13,14 In all cases of harlequin syndrome related to asymmetric epidural anesthesia, investigators [13][14][15]17 have theorized that a marked rostral distribution of the local anesthetic in a unilateral fashion resulted in blockade of sympathetic innervation of the face and the resulting harlequin syndrome. Local distribution of anesthetic in the epidural space is more likely to proceed cephalad when the drug is injected in a low thoracic site (T6-L1).…”

Harlequin Syndrome Following Implantation of Intrathecal Pumps: A Case Series

“…Even though the etiology is not well defined, the condition has been associated with one‐sided sympathetic denervation of the face. Case reports associate HS with certain thoracic tumors , thoracic surgeries , neck masses , or neck surgery , and neuraxial anesthesia . However, to the best of our knowledge, this is the first case series of HS following implantation of an intrathecal drug delivery system.…”

Harlequin appearance postepidural analgesia in a child following thoracotomy

“…Lance and colleagues in 1988 (2) were the first to give a descriptive label of‘harlequin syndrome’ to five patients with sudden onset unilateral facial flushing brought on by hot weather or strenuous exercise. There are case reports of harlequin syndrome in adults following high thoracic paravertebral block (3), internal jugular vein catheterization (1) and asymmetrical high epidural block (4).…”