Trigeminal nerve palsy and Horner’s syndrome following epidural analgesia for labor: a subdural block?

Horner′s syndrome and weakness of upper limb after epidural anaesthesia for caesarean section

“…[1415] Unilateral Horner's syndrome along with weakness of upper arm on the same side is difficult to explain and presence of midline septum has been suggested as the cause. [16] We could not provide the evidence for the same in our case as patient refused to undergo MRI. Regarding test dose, there is no consensus on the exact nature of the epidural test dose in obstetrics, as no single regimen has been proven to be completely effective as an epidural test dose.…”

Unilateral Horner’s Syndrome and Trigeminal Nerve Palsy After Lumbar Epidural Anaesthesia for Cesarean Section

“…This predilection may result from the anatomic and physiological changes that occur in pregnancy and favor the cephalad spread of the anaesthetic: narrowing of the epidural space as a result of distention of epidural veins; increased water content of connective tissues; partial occlusion of the inferior vena cava that diverts the blood through the epidural plexus venosus; and high progesterone levels increasing nervous fibers sensitivity to the local anaesthetic. 1 , 8 , 9 …”

“… 1 , 2 , 4 Paresthesia of the trigeminal nerve territory can also be a concomitant symptom likewise in our case. 8 , 10 The spinal trigeminal tract of the trigeminal nerve extends caudally until the second cervical segment, and the occurrence of trigeminal nerve palsy could be explained by high cephalad spread of the local anaesthetic. 4 , 11 …”

“…Additionally, accidental migration of the catheter to the subdural space might allow local anaesthetic to spread more cephalic dermatomes than expected. 8 , 13 Because the subdural space extends beyond the foramen magnum and risk of subdural location of the catheter could explain trigeminal nerve involvement. 4 , 8 …”

Delayed Cranial Nerve Palsies and Chiari Type I Malformation After Epidural Anesthesia in the Setting of Childbirth

“…While CN VI appears to be the most frequently affected nerve after epidural anesthesia in these series, other CN palsies are also reported. Multiple case reports describe the co-occurrence of CN V palsy and Horner’s syndrome following epidural anesthesia [ 13 - 16 ], with one case also affecting CN XII [ 15 ]. Epidural anesthesia is also rarely associated with more severe neurologic complications, including cortical vein thrombosis and subdural hematoma [ 17 ].…”