Coexisting harlequin and Horner syndromes after high thoracic paravertebral anaesthesia

Abstract

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. © The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved.