1/6. Acute horner syndrome due to thoracic epidural analgesia in a paediatric patient.A 4-year-old boy with coarctation of the aorta underwent surgical aortic arch repair with general anaesthesia and thoracic epidural analgesia. In the immediate postoperative period, the child developed a unilateral horner syndrome which appeared to be related to the epidural infusion rate. Management of this patient as well as alternate aetiologies of horner syndrome are described. horner syndrome is a rare complication of epidural catheters and is often unrecognized, especially in children.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/6. Coexisting harlequin and Horner syndromes after high thoracic paravertebral anaesthesia.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.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
3/6. Sympathetic paraganglioma presenting with Horner's syndrome in a child.Paragangliomas of the head and neck arise from collections of cells from the neural crest associated with cranial or sympathetic nerves. Such lesions are rare in children. The majority of paragangliomas in the paediatric age groups have been familial, occurring in association with an adrenal pheochromocytoma. Children typically present with a neck mass and systemic evidence of catecholamine hypersecretion. We present the case of a 12-year-old boy with a history of increasing headache, drowsiness and Horner's syndrome for 8 months. The patient underwent exploration of the neck mass under general anaesthesia. The lesion was found to be in continuity with the left sympathetic chain. It was highly vascular but was removed en mass and sent for histological analysis. The histology showed that the mass was a well-circumscribed encapsulated tumour and that complete excision was achieved. The post-operative period was uneventful and the patient recovered well after the operation. On review at 6 months following surgery, his scars were maturing satisfactorily but the Horner's syndrome was persistent. Sympathetic chain paragangliomas are very rare tumours in the head and neck but should be considered in the differential diagnosis when clinical and radiographic evidence suggest a paraganglioma. The presentation is typically of a slow-growing neck mass with the presence of an ipsilateral Horner's syndrome. To our knowledge, this is the first reported case of a sympathetic chain paraganglioma in a child.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/6. Horner's syndrome and trigeminal nerve palsy following epidural anaesthesia for obstetrics.While Horner's syndrome is a rare but occasionally reported side-effect of epidural block administered for labour, trigeminal nerve palsy has been described only once. The cases described in this report confirmed the benign nature of these neurological complications of epidurally administered anaesthetics which were not detrimental to fetal viability. The complications may be attributed to extensive cephalad spread of local anaesthetic, sometimes via unexplained routes and with surprisingly selective targeting effect (unilateral trigeminal nerve palsy). The atypical and unusually high cephalad spread of local anaesthetic in pregnant women at term is believed to be due to pregnancy-related altered anatomy and physiology of the epidural space.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
5/6. Horner's syndrome during epidural anaesthesia for elective caesarean section.Twenty ml of three per cent chloroprocaine solution was injected into the lumbar epidural space of a parturient for anaesthesia for elective caesarean section. Ten minutes after injection of the anaesthetic, the patient developed Horner's syndrome on the left side. The anaesthetic level was C7 on the affected side. Thirty minutes after the bolus dose of chloroprocaine the signs disappeared, at which time the patient received a reinforcing dose of 10 ml of chloroprocaine three per cent. The Horner's complex reappeared in eight minutes and persisted for 20 minutes. While Horner's syndrome is not uncommon in women in labour receiving lumbar epidural anaesthesia, it is virtually unknown in patients who are not in labour. The mechanism for the appearance of the syndrome in this case is unclear. The most likely explanation is that only a small amount of local anaesthetic was necessary to produce the syndrome and the subsequent bolus of anaesthetic followed pathways opened by the original dose, since a much smaller amount of anaesthetic was necessary to reproduce the syndrome.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |
6/6. Horner's syndrome resulting from a prolonged abnormal posture during a coma.BACKGROUND: Horner's syndrome results from the impairment of the sympathetic nerve supply to the eye and orbit. Other nerve palsies from prolonged unchanged posture are well described, but Horner's syndrome following prolonged lateral flexion has only twice been seen previously and these cases were in association with anaesthesia. methods/RESULTS: A case is described of Horner's syndrome resulting from a prolonged period of unchanged posture from an alcohol-induced coma. A review of the anatomy of Horner's syndrome is presented. CONCLUSION: To my knowledge, this is the first reported case of Horner's syndrome resulting from a coma.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |