Horner’s Syndrome and Upper Limb Paresthesia During Labor Epidural Analgesia: A Case Report

Crisóstomo, João; Dias, Carolina Náglio Kalil; Pedro, Daniel; Pires, Rafael; Rocha, Teresa

doi:10.7759/cureus.21388

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…7 This phenomenon is more common in pregnancy due to the narrowing of the epidural space due to an enlarged uterus and engorged epidural veins. 7,8 It is rarer in nonparturient patients and even fewer cases with thoracic epidurals have been reported. Additionally, this patient had an elevated BMI which may have led to larger cephalad spread from increased abdominal pressure and inaccurate estimation of vertebral level resulting in higher than anticipated epidural placement.…”

Section: Discussionmentioning

confidence: 99%

Subdural Spread of Local Anesthetic Mimicking Cerebrovascular Accident: A Case Report of Horner’s Syndrome, Upper Limb Paresthesia, and Motor Weakness After Thoracic Epidural Analgesia

Measer,

Gray,

Braehler

2024

A&A Practice

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A 53-year-old woman underwent a thoracic epidural placement for a scheduled laparotomy. Postoperatively the patient had no appreciable epidural level after multiple epidural boluses and was noted to be severely hypotensive with right upper extremity weakness and numbness. She subsequently developed right-sided Horner’s syndrome with worsening right upper extremity weakness and decreased sensation from C6 to T1. She regained full motor and sensory function in her right upper extremity with epidural removal. This unusual case raises awareness of the variability in the presentation of subdural spread and provides an example of an epidural complication that can mimic a cerebrovascular accident (CVA).

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Section: Discussionmentioning

confidence: 99%

Subdural Spread of Local Anesthetic Mimicking Cerebrovascular Accident: A Case Report of Horner’s Syndrome, Upper Limb Paresthesia, and Motor Weakness After Thoracic Epidural Analgesia

Measer,

Gray,

Braehler

2024

A&A Practice

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“…It is important to note that the closure of the carotid artery sheath with an ultrasonic knife for separating the thyroid gland from the surrounding lymphoid and adipose tissue may result in temporary or permanent nerve damage due to heat conduction ( 15 ). In addition, there are other factors that can potentially cause Horner’s syndrome, including but not limited to thyroid neoplasms or huge goiter compression ( 3 ), arteritis ( 16 ), central nervous system infection ( 3 ), peridural obstetric anesthesia ( 17 , 18 ), and occasionally lung transplantation.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of HS after endoscopic thyroid surgery: case report and brief literature review

Deng,

Ding

2023

Front. Surg.

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BackgroundHorner’s syndrome (HS) is a rare condition due to damage to the 3-neuron sympathetic pathway anywhere between the posterior-lateral nuclei of the hypothalamus and the oculosympathetic fiber, particularly as a post-thyroidectomy symptom. In this case report, we present a case of HS following endoscopic thyroid surgery (ETS) and briefly review the literature.Case reportDuring a routine physical examination, a 29-year-old female patient was incidentally found to have multiple nodules in the right thyroid. She was subsequently admitted to the Department of General Surgery for further examinations and treatment. A fine-needle aspiration biopsy confirmed malignancy in these nodules. As a result, the patient underwent radical resection of the right thyroid and ipsilateral central lymph node dissection using endoscopy. Pathological diagnosis revealed papillary thyroid carcinoma. Unexpectedly, on the third day after the operation, the patient was diagnosed with Horner’s syndrome based on the presence of miosis and ptosis. After 1 week of follow-up, the symptoms related to HS significantly improved.ConclusionHorner’s syndrome is an uncommon complication of thyroidectomy in patients undergoing ETS. Therefore, it is crucial to perform careful operations and minimize iatrogenic surgical damage to reduce the incidence of HS. This case serves as a reminder that making rational judgments and implementing appropriate measures are essential for achieving a favorable prognosis and preserving facial esthetics.

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“…We exclude the epidural as a cause of HS once it was removed 24 hours before the onset of HS. Cervical plexus fiber blockade due to epidural drug administration starts after an average of 27 minutes [ 18 ]. The drug used 24 hours earlier was ropivacaine, which has an average mean absorption t1/2 of approximately 4.2 hours so it could not be the cause of HS [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Horner's Syndrome as a Complication of Ultrasound-Guided Central Cannulation: A Case Report

Silva¹,

Junqueira²,

Pato³

et al. 2022

Cureus

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Cannulation of the internal jugular vein is often necessary for the management of critically ill patients. Despite being a very common procedure and performed more and more safely, several complications still occur. Horner's Syndrome (HS) is one of those complications described before the use of ultrasound as a method of guidance. HS is caused by functional interruption of sympathetic nerve supply to the eye, leading to a classic triad of ipsilateral ptosis, miosis, and anhidrosis. We present the case of a patient, in need of emergent surgery to control the hemorrhagic focus after delivery, with a transient HS secondary to internal jugular vein cannulation under real-time ultrasound guidance.

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Horner’s Syndrome and Upper Limb Paresthesia During Labor Epidural Analgesia: A Case Report

Cited by 3 publications

References 6 publications

Subdural Spread of Local Anesthetic Mimicking Cerebrovascular Accident: A Case Report of Horner’s Syndrome, Upper Limb Paresthesia, and Motor Weakness After Thoracic Epidural Analgesia

Subdural Spread of Local Anesthetic Mimicking Cerebrovascular Accident: A Case Report of Horner’s Syndrome, Upper Limb Paresthesia, and Motor Weakness After Thoracic Epidural Analgesia

Diagnosis and treatment of HS after endoscopic thyroid surgery: case report and brief literature review

Horner's Syndrome as a Complication of Ultrasound-Guided Central Cannulation: A Case Report

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