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BJA Advance Access published online on October 14, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei258
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted July 11, 2005

Case Report

Coexisting harlequin and Horner syndromes after high thoracic paravertebral anaesthesia

C. L. Burlacu 1* and D. J. Buggy 1

1 Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland

* To whom correspondence should be addressed.
C. L. Burlacu, E-mail: crina{at}ireland.com


  Abstract

A patient undergoing left mastectomy and immediate latissimus dorsi breast reconstruction under combined paravertebral block and general anaesthesia developed transient, well-demarcated, right-sided hemifacial erythema and sweating, and left-sided Horner syndrome postoperatively. This ‘harlequin’ appearance occurs because of a normal or excessive vasodilatory, thermoregulatory response to heat or emotion mediated by an intact sympathetic pathway on the erythematous side, together with relative pallor of the pharmacologically blocked side.

Keywords: anaesthetic techniques, regional, paravertebral; sympathetic nervous system, ganglion block.
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E-letters:

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Coexisting Harlequin and Horners Syndromes after high thoracic paravertebral block
Dr Anjalina Majumder, et al.
British Journal of Anaesthesia, 11 Sep 2006 [Full text]
Perioperative Harlequin syndrome
Crina L. Burlacu, et al.
British Journal of Anaesthesia, 15 Sep 2006 [Full text]

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