Late Postoperative Harlequin Syndrome Coexisting With Horner Syndrome After Thoracic Epidural Anesthesia

The predominant features of Harlequin syndrome are unilateral facial flushing and sweating. Harlequin syndrome has been reported in different clinical conditions including brain stem infarction, superior mediastinal neurinoma, and internal jugular vein catheterization.1,2 Idiopathic and iatrogenic cases have been reported. The clinical features of Horner syndrome are ptosis, miosis, enophthalmos and anhidrosis. Horner syndrome is generally reported after trauma, stroke and mediastinal tumors, due to autonomic system disturbances.3–5 A few cases of coexisting Harlequin and Horner syndromes due to anesthesia have been reported in the literature. Burlacu and Buggy reported a transient coexisting unilateral Horner and Harlequin syndromes after upper thoracic paravertebral block in combination with general anesthesia.6 We present a patient who had coexisting Harlequin and Horner syndromes after thoracic epidural anesthesia (TEA) for left modified radical mastectomy, and discuss the clinical features and correlation with TEA.