Harlequin Syndrome as a Complication of Epidural Anesthesia

Abstract

Harlequin syndrome is a rare neurological condition that results in unilateral facial flushing and sweating. Although the syndrome is generally a benign condition with complete resolution if appropriate treatment is initiated, unilateral facial flushing can be a sign of several serious conditions and should be thoroughly investigated. Sudden onset of facial flushing related to harlequin syndrome developed in a patient who had bilateral lung transplant with postoperative epidural anesthesia for pain control. Differential diagnosis includes neurovascular disease (acute stroke), malignant neoplasm of brain or lung, Horner syndrome, idiopathic hyperhidrosis, and Frey syndrome. Harlequin syndrome is often easily treated by discontinuing the anesthetic or adjusting placement of the epidural catheter. (Critical Care Nurse. 2014;34[3]:57–61)

Idiopathic harlequin syndrome: a case report and literature review

“…The absence of erythema or sweats on one side of the hemiface should make us look for an anomaly on this side [8], several etiologies have been reported, at the top of the list tumors of the cervicobrachial plexus [9], like neuroblastoma. A reported case of harlequin syndrome has been described in an adult associated with hypochromia of the iris, with the underlying anomaly being C1L1 nerve compression [4].…”

“…A reported case of harlequin syndrome has been described in an adult associated with hypochromia of the iris, with the underlying anomaly being C1L1 nerve compression [4]. The rest of the etiologies are dominated by diabetic neuropathies, Guillain Barré syndrome, Bradbury Egleston syndrome, toxic goiter [9] cervicobrachial plexus pathology [9], medullary infarct, carotid dissection [3] cervical lymphatic malformation. However, this syndrome can rarely complicate cervico-spinal surgery [10].…”

İdyopatik Harlequin Sendromlu Nadir Bir Olgu

“…Harlequin Sendromu yaygın olarak idyopatik özellik gösterse de, sempatik lifleri baskılayan tümöral ve/veya vasküler oluşumlar, beyin sapı lezyonları, siringomiyeli, gullian-barre sendromu, diyabetik otonomik nöropati, mutiple skleroz, invazif girişimler gibi heterojen dağılım gösteren hastalıklara ikincil de görülebilir (3,7). Bu nedenlerin dışlanmasında, beyin ve servikal ve torakal görüntüleme yöntemleri önemlilik gösterir (8).…”

“…Genellikle egzersiz, ısı artışı, emosyonel stresle belirginleşen tablo, servikal sempatik zincirin vazomotor ve sudamotor liflerindeki hasara ikincildir (2). Travma, cerrahi girişim gibi invazif nedenler, nörodejeneratif ya da serebrovasküler hastalıklar etyolojide yer alabilse de birçok vaka idyopatik olarak kalmaktadır (3). Burada idyopatik harlequin sendromlu bir olgu paylaşılmıştır.…”

Idiopathic Harlequin Syndrome Manifesting during Exercise: A Case Report and Review of the Literature

“…The syndrome also might be caused by brainstem infarction, carotid artery dissection, toxic goiter, superior mediastinal neurinoma, syringomyelia, multiple sclerosis, internal jugular vein catheterization, and iatrogenic effects of invasive procedures [5]. It is usually acquired but can be congenital in up to 6% of the reported cases [6].…”