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Harlequin syndrome, causing one-sided facial flushing, can occur after nerve blocks. This case highlights its occurrence without Horner syndrome following thoracic paravertebral nerve block.

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Area of Science:

  • Neurology
  • Anesthesiology

Background:

  • Harlequin syndrome presents as sudden unilateral facial flushing and sweating.
  • It is often linked to sympathetic nervous system interruption, though mechanisms are not fully understood.

Observation:

  • A patient developed Harlequin syndrome with right-sided facial flushing post-left-sided thoracic paravertebral nerve block for mastectomy.
  • Notably, this instance did not involve Horner syndrome.

Findings:

  • The case suggests thoracic paravertebral nerve block can interrupt sympathetic and parasympathetic pathways.
  • The specific spinal nerve block levels involved require further investigation.

Implications:

  • This case expands the understanding of Harlequin syndrome's potential triggers and presentations.
  • It underscores the importance of considering autonomic nervous system effects after regional anesthesia.