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Harlequin syndrome.

Rohan Sharma1, Humaira Khan2,3

  • 1Department of Neurocritical Care, Mayo Clinic Florida, 4500 San Pablo Road S, Jacksonville, FL, 32258, USA. Sharma.rohan@mayo.edu.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
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Summary
This summary is machine-generated.

This case study highlights Harlequin syndrome, a rare condition involving unilateral facial flushing opposite to Horner's syndrome. Effective treatment involved erenumab for migraine prophylaxis and sumatriptan for acute episodes.

Keywords:
Autonomic headachesHarlequin syndromeHorner’s syndrome

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Area of Science:

  • Neurology
  • Ophthalmology

Background:

  • Headaches with autonomic dysfunction can mimic other neurological conditions.
  • Horner's syndrome, characterized by ptosis and miosis, can be idiopathic or secondary to other pathologies.

Observation:

  • A 56-year-old man presented with episodic headaches, left eye ptosis, and miosis.
  • During headache episodes, he experienced left-sided facial flushing, nausea, vomiting, photophobia, and phonophobia.
  • Extensive workup, including neuroimaging, was unremarkable.

Findings:

  • The patient was diagnosed with idiopathic left Horner's syndrome.
  • His migraines with autonomic dysfunction presented as Harlequin syndrome, with unilateral flushing opposite to the Horner's syndrome side.
  • Treatment with erenumab and sumatriptan led to symptom improvement.

Implications:

  • This case expands the understanding of Harlequin syndrome presentation in conjunction with Horner's syndrome.
  • It underscores the importance of considering rare autonomic cephalalgias in patients with complex headache patterns.
  • Successful management highlights the role of targeted migraine therapy in managing associated autonomic features.