Work

Recurrent Horner’s Syndrome and Cranial Nerve Involvement Following Epidural Analgesia During Labor: A Case Report

Year: 2026

Type: article

Abstract: We report a rare case of a 33-year-old primigravida developing an extensive cephalad spread of epidural local anesthetic resulting in bilateral Horner's syndrome and cranial nerve involvement during labor and cesarean delivery. Urgent neuroimaging excluded intracranial hemorrhage. Due to persistent focal neurological symptoms during second-stage labor and inability to exclude a life-threatening cerebrovascular pathology, cesarean delivery was performed for maternal indication. Following epidural top-up for surgical anesthesia, symptoms recurred and progressed bilaterally, thereby supporting extensive cephalad spread as the underlying mechanism. Postpartum MRI and MR angiography revealed no cerebrovascular abnormalities. This case illustrates the diagnostic challenge of acute neurological symptoms during labor, where pregnancy-associated stroke risk necessitates exclusion of life-threatening pathology despite time constraints. Recognition of pregnancy-related factors predisposing to extensive epidural spread, combined with interdisciplinary collaboration and appropriate neuroimaging, enabled safe management.

Source: Case Reports in Anesthesiology

DOI: 10.1155/cria/4477329

Authors: Cristine Cavegn, Evgenia Anastasiadou, Maria Lünnemann, Romana Brun, Daniel Anthony Button, Caveh Madjdpour

Institution: Kantonsspital Winterthur

Language: English

Topic: Anesthesia and Pain Management

Subfield: Anesthesiology and Pain Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $790