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

Abstract

Horner's syndrome is a condition that results from sympathetic nervous system dysfunction. Labor epidural analgesia is known to be a rare cause of Horner's Syndrome. However, in the obstetric population, the incidence of Horner's Syndrome is higher than in the rest of the population as it is a consequence of high cephalad spread of local anesthetic (LA) probably enhanced by the anatmophysiologic changes of pregnancy. We present a case of unilateral Horner's syndrome as a complication of epidural analgesia with accompanying upper limb paresthesia and motor weakness, a rarely encountered symptom.

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

“…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.…”

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

“…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.…”

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

“…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 ].…”