SciELO - Scientific Electronic Library Online

 
vol.53 issue4Brainstem hemorrhage after surgical removal of arachnoid cyst of the sylvian fissure: case reportBenign chondroblastoma of the occipital bone: case report author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

Share


Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.53 no.4 São Paulo Dec. 1995

https://doi.org/10.1590/S0004-282X1995000500022 

Horner's syndrome and brachial paresis as a complication of lumbar sympathetic block. A case report

 

Síndrome de Horner e paresia braquial como complicação de bloqueio simpático lombar: relato de caso

 

 

Pa. Maranhão-FilhoI; M.A.O. MartinsII; H.F. LopesIII

INeurologist. Department of Neurosurgery, National Cancer Iinstitute (INCa), Rio de Janeiro, Brazil
IIAnaesthesiologist. Department of Neurosurgery, National Cancer Iinstitute (INCa), Rio de Janeiro, Brazil
IIINeurosurgeon. Department of Neurosurgery, National Cancer Iinstitute (INCa), Rio de Janeiro, Brazil

 

 


SUMMARY

An unusual case of Homer's syndrome secondary to a sympathetic block in a patient with chronic adhesive arachnoiditis (CAA) is described. The patient, a 40-year-old white woman, presented with spastic paraplegia, hyperreflexia, bilateral Babinski sigh, superficial and deep sensitive hypoaesthesia at the T4 level, in addition to bladder and rectal dysfunction since she was 32. At age of 38 she complained of excessive daily sweating below the T4 level, mostly at night. A 4mL 0.5% bupivacaine lumbar sympathetic block was performed. Within 15 min aright brachial paresis and an ipsilateral Horner's syndrome were noted. Speculatively, an abnormal cephalic spread of the anaesthesic due to a putative erratic space secondary to the CAA may justify the clinical picture even using a relatively small amount of anaesthesic (4 mL).

Key words:lumbar sympathetic block, chronic adhesive arachnoiditis, Horner's syndrome.


RESUMO

Os autores descrevem o caso de uma mulher branca de 40 anos de idade, com paraplegia espástica, hiperreflexia, sinal de Babinski bilateral, hipoestesia superficial e profunda em T4, além de incontinência fecal e urinária, desde os 32 anos decorrente de aracnoidite crônica adesiva (CAA). Aos 38 anos passou apresentar sudorese excessiva com limite superior em T4, diária, com intensificação noturna. Um bloqueio simpático lombar foi efetuado com 4mL de bupivacaina 0.5%. Quinze minutos depois a paciente apresentou monoparesia braquial direita e síndrome de Horner ipsolateral. Devido provavelmente a um espaço peridural estreito e errático, secundário à CAA, pode-se justificar o quadro clínico como secundário à ascenção cranial do anestésico, mesmo utilizado em reduzida quantidade (4mL).

Palavras Chave: bloqueio simpático lombar, aracnoidite crônica adesiva, síndrome de Horner.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

Aknowledgement - We are indebted to Dr. Maurice Vincent for assistance.in preparing this manuscript.

 

REFERENCES

1.  Blomberg R. The dorsomedian connective tissue band in lumbar epidural space of humans: an anatomical study using epiduroscopy in autopsy cases. Anesth Analg. 1986, 65:747-752.         [ Links ]

2.  Burn JM, Guyer PB, Langdon L. The spread of solutions injected into the epidural space. Br. J Anaesth 1973, 45:338-345.         [ Links ]

3.  Clayton KC. The incidence of Horner's syndrome during lumbar extradural for eletive caesarean section and provision of analgesia during labor. Anaesthesia 1983, 38:583-585.         [ Links ]

4.  DeJong RN. The neurologic examination. Ed 4. New York: Harper & Row, 1979, p 127.         [ Links ]

5.  Evans JM, Gauci CA, Watkins G. Horner's syndrome as a complication of lumbar epidural block. Anesthesia 1975, 30:774-777.         [ Links ]

6.  Mohan J, Potter JM. Pupillary constriction and ptosis following caudal epidural analgesia. Anaesthesia 1975, 30:769-773.         [ Links ]

7.  Wilkins RH, Brody IA, Durham NC. Homer's Syndrome. Arch Neurol 1968, 19:540-542.         [ Links ]

8.  Wills MH, Korbon GA, Arasi R. Horner's syndrome resulting from a lumbar sympathetic block. Anesthesiology 1988, 68:613-614.         [ Links ]

 

 

Aceite: ll-maio-1995.

 

 

Dr. Péricles A. Maranhão Filho, - Av. Canal de Marapendi 1680 apt 1802. - 22631-050 Rio de Janeiro RJ -Brasil. Fax (+55.21) 4395594.

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License