Abstract
Horner syndrome is a facial triad of miosis, ptosis, and anhidrosis. It is produced by a lesion of the sympathetic pathway supplying the head, eye, and neck. Causes range from benign to serious. Epidural anesthesia is widely used during obstetrics and general surgery. Although generally a safe procedure, it can cause neurologic and ophthalmologic complications. We report a case of unilateral Horner syndrome in a 43-year-old woman with Ehlers-Danlos syndrome (EDS). The patient underwent bowel and urogenital surgery under general anesthesia supplemented with L4-L5 epidural anesthesia. Horner syndrome may have been promoted by increased local anesthetic spread permitted by the connective tissue dysfunction of EDS. Furthermore, the patient suffered chronic constipation as a complication of EDS, and straining may have promoted upward spread of the local anesthetic. In addition, weakness of the dura and/or ligamentum flavum might predispose to subdural migration of epidural catheters in patients with EDS. Accordingly, EDS may increase the likelihood of a Horner syndrome following epidural anesthesia.
Highlights
Horner syndrome refers to the constellation of signs resulting from the interruption of sympathetic innervation to the eye and ocular adnexa
Lumbar or low-thoracic epidural anesthesia is widely used during obstetrics and general surgery
We report a case of Horner syndrome in a woman with Ehlers-Danlos syndrome (EDS) undergoing bowel and urogenital surgery under general anesthesia supplemented with lumbar epidural anesthesia
Summary
Horner syndrome refers to the constellation of signs resulting from the interruption of sympathetic innervation to the eye and ocular adnexa. Horner syndrome can be seen following several regional anaesthetic techniques, including brachial plexus block and epidural anaesthesia. Lumbar or low-thoracic epidural anesthesia is widely used during obstetrics and general surgery. As a recognized complication of epidural anesthesia, Horner syndrome has mainly been described in obstetrical patients. It is rare and unpredictable, and its course is usually benign and transient. This was Type III with symptoms of joint and spine hypermobility, joint dislocations, chronic joint pain, soft and smooth skin, megacolon, and delayed gastric emptying. General anesthesia was supplemented by regional via a pre-operatively placed lumbar epidural catheter (L4-L5). The patient did not manifest any other symptoms or signs
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
