Horner Syndrome After Lumbar Epidural Analgesia in a Patient with Ehlers-Danlos Syndrome | oneedsvoice

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Horner Syndrome After Lumbar Epidural Analgesia in a Patient with Ehlers-Danlos Syndrome

key information

source: The Open Anesthesiology Journal

year: 2017

authors: Xiangyi Kong, Theodore A. Alston, Jingping Wang

summary/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.

organisation: Peking Union Medical College Hospital, Massachusetts General Hospital, Harvard University

DOI: 10.2174/1874321801711010012

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