Horner Syndrome Following Internal Jugular Vein Catheter Insertion: Report of Two Cases

Abstract

Horner syndrome is a rare complication which may occur following the insertion of a catheter in to the internal jugular vein. We present two cases of Horner syndrome (HS) which occured following internal jugular venous cannulation

Iatrogenic Horner’s syndrome after insertion of a central venous catheter: recommendations for clinical practice

“…They are enlisted in detail in Table 1. Maloney et al reported that in about 450 patients with HS, only about 65% (270 individuals) had an identifiable etiology, of which 13% were central, 44% preganglionic, and 43% postganglionic [5].…”

“…These complications include carotid artery aneurysm (most common), aortic dissection, thrombosis, arteriovenous fistula formation, pneumothorax, and HS [6]. Ways in which a CVC may cause HS include direct damage to the sympathetic chain, direct damage to the peri-subclavian neural loops, and hematoma of associated vasculature (especially if the hematoma is trapped within the carotid sheath) [3][4][5][6].…”

“…Once the head is tilted to the left by more than 40 o , the risk of IJV overlapping the carotid artery is increased significantly, leading to greater chances of developing HS. Tilting the head within 30 o and keeping the neck muscles relaxed leads to higher success rates and minimizes the patient's discomfort [5]. 4.…”

“…Testing for HS can be positive with apraclonidine as soon as 3 h after the insult. Pharmacological testing should be done as soon as possible and once HS is diagnosed and attributed to catheter insertion; the CVC should be removed by a specialist to limit further damage [5]. 5.…”

“…Causes and clinical manifestations with respect to level of lesion for Horner's syndrome (derived from multiple sources[1,4,5])…”