Persistent Hornerʼs Syndrome After Spinal Fusion and Epidural Analgesia

Hered, Robert W.; Cummings, R. Jay; Helffrich, R

doi:10.1097/00007632-199802010-00021

Cited by 18 publications

(13 citation statements)

References 10 publications

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“…The exact cause of this sustained Horner's syndrome is not clear. 13,14 Another related case reported Horner's syndrome in a 32-year-old woman 2 weeks after a prolonged labor with spinal anesthesia. Her findings of miosis and ptosis were accompanied by head and neck pain, which was subsequently discovered to be due to internal carotid artery dissection.…”

Section: Discussionmentioning

confidence: 99%

Horner's Syndrome and Trigeminal Nerve Palsy following Epidural Analgesia for Labor

Lynch

Keneally²,

Hustead³

2006

The Journal of the American Board of Family Medicine

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Epidural analgesia is a widely used method of pain control in the labor and delivery setting but is not without risks. We present a case of Horner's syndrome and trigeminal nerve palsy as a rare complication of epidural analgesia in an obstetric patient. Although reported in few instances in the anesthesia literature, awareness among providers in obstetrics is critical because this could be the first sign of a high sympathetic blockade resulting in potential maternal-fetal morbidity. Case ReportA healthy 25-year-old woman, gravida 2 para 1, was admitted to the hospital for active labor at 39 weeks gestation. Her past medical history was remarkable only for occasional migraine headaches, and her prenatal course, including labs, had been unremarkable. During an uneventful first stage of labor, epidural anesthesia was requested. A lumbar epidural catheter was placed at the interspace between the third and fourth lumbar vertebrae using a midline approach and a loss of resistance to saline through a 17-gauge Touhy needle. A test dose of 3 mL of 1.5% lidocaine with 5 g of epinephrine per milliliter was administered without appreciable evidence of either intravascular or intrathecal placement of the catheter. A bolus of 10 mL of 0.2% bupivacaine with 2 g of fentanyl per milliliter was administered over 10 minutes, and then an infusion of the same solution was started at 8 mL per hour. Approximately 20 minutes after epidural catheter placement, the patient complained that the left side of her face "felt funny." On evaluation by her family physician, the patient reported decreased sensation to light touch on the left cheek in the distribution of the maxillary branch of the trigeminal nerve and was observed to have miosis and ptosis on the left side. Pinprick demonstrated the level of analgesia at the fourth thoracic segment on the left and at the fifth thoracic segment on the right. The patient's grip strength was found to be normal, and she denied dyspnea. There were no other cranial nerve abnormalities or neurologic deficits appreciated.Simultaneously, the patient's blood pressure dropped from 115/68 mm Hg to a range of 90s/30s mm Hg for several minutes. After receiving 10 mg of ephedrine IV, her blood pressure returned to 110s/50s mm Hg, but her neurologic symptoms persisted. During this period, fetal monitoring was uneventful without decelerations or bradycardia. Due to concerns for these neurologic findings, the epidural infusion was stopped, and labor allowed to progress. About 30 minutes after stopping the infusion, the patient's symptoms of facial numbness, ptosis, and miosis resolved.Within the hour, the patient desired further pain control with epidural anesthesia. Therefore, she was repositioned, and an infusion of the same solution was started at 6 mL per hour without a bolus. This was followed by an uneventful progression of labor and vaginal delivery of a healthy male infant. No further signs or symptoms of Horner's syndrome or trigeminal nerve palsy were evident during the rest of this patient's labor, de...

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Section: Discussionmentioning

confidence: 99%

Horner's Syndrome and Trigeminal Nerve Palsy following Epidural Analgesia for Labor

Lynch

Keneally²,

Hustead³

2006

The Journal of the American Board of Family Medicine

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“…Finally, cases of recurrent Horner's syndrome and persistent Horner's syndrome requiring eyelid surgery have been described after epidural analgesia as well. [1011] In the present case, weakness of upper-limb with Horner's syndrome and visual disturbances made us worried. However, all the features were transient, recovered spontaneously and did not require any treatment.…”

Section: Discussionmentioning

confidence: 78%

Horner′s syndrome and weakness of upper limb after epidural anaesthesia for caesarean section

Jadon

2014

Indian J Anaesth

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Horner's syndrome is not rare during labour epidural analgesia or in pregnant patients receiving epidural anaesthesia for caesarean section as thought previously. It occurs due to blockade of sympathetic fibres supplying the eye and face area. Most of the times it is a benign and self-limiting condition; however, it may become a serious systemic manifestation. We present a case where patient had weakness of upper-limb and Horner's syndrome of same side with visual disturbances. These symptoms were transient and resolved spontaneously without any treatment.

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“…The persistence of Horner's syndrome may warrant formal cranial, cervical and vascular imaging. The literature highlights cases with symptoms persisting up to 6 months from original insult [ 11 ]. We note a case report by Mueller et al [ 12 ] who described Horner's syndrome after scoliosis correction without the use of epidural anaesthesia that was related to hook placement around the T4 pedicle.…”

Section: Discussionmentioning

confidence: 99%

Horner's Syndrome Secondary to Epidural Anaesthesia Following Posterior Instrumented Scoliosis Correction

2015

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An 11-year-old girl underwent T4 to L1 posterior instrumented scoliosis correction for adolescent idiopathic scoliosis. Postoperative clinical examination revealed left-sided Horner's syndrome which was preceded by left-sided C8 paraesthesia. The Horner's syndrome resolved after 14 hours following weaning and removal of the epidural catheter. Horner's syndrome following posterior instrumented scoliosis correction associated to epidural use is extremely rare. Surgeons must be aware of the risks of epidural placement and the need for close monitoring of associated complications. Alternative aetiology producing a Horner's syndrome must always be considered because of its devastating long term sequela if missed.

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Persistent Hornerʼs Syndrome After Spinal Fusion and Epidural Analgesia

Abstract: This is the first reported case of Horner's syndrome occurring after posterior spinal fusion and epidural analgesia.

Cited by 18 publications

References 10 publications

Horner's Syndrome and Trigeminal Nerve Palsy following Epidural Analgesia for Labor

Horner's Syndrome and Trigeminal Nerve Palsy following Epidural Analgesia for Labor

Horner′s syndrome and weakness of upper limb after epidural anaesthesia for caesarean section

Horner's Syndrome Secondary to Epidural Anaesthesia Following Posterior Instrumented Scoliosis Correction

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