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Peer-reviewedCC BYCase reports in anesthesiology

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

  • Cristine Cavegn1
  • Evgenia Anastasiadou2
  • Maria Lünnemann1
  • Romana Brun2
  • Daniel Anthony Button1
  • Caveh Madjdpour1
  1. 1Department of Anesthesiology Kantonsspital Winterthur Brauerstrasse 15 Winterthur 8400 Switzerland ksw.ch.
  2. 2Department of Obstetrics and Gynecology Kantonsspital Winterthur Brauerstrasse 15 Winterthur 8400 Switzerland ksw.ch.
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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.

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Cite

BibTeXRIS
BibTeX
@article{cavegn2026recurrent,
  title = {{Recurrent Horner's Syndrome and Cranial Nerve Involvement Following Epidural Analgesia During Labor: A Case Report.}},
  author = {Cristine Cavegn and Evgenia Anastasiadou and Maria Lünnemann and Romana Brun and Daniel Anthony Button and Caveh Madjdpour},
  journal = {Case reports in anesthesiology},
  year = {2026},
  month = nov,
  doi = {10.1155/cria/4477329},
  url = {https://europepmc.org/article/MED/42974378},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Recurrent Horner's Syndrome and Cranial Nerve Involvement Following Epidural Analgesia During Labor: A Case Report.
AU  - Cristine Cavegn
AU  - Evgenia Anastasiadou
AU  - Maria Lünnemann
AU  - Romana Brun
AU  - Daniel Anthony Button
AU  - Caveh Madjdpour
PY  - 2026
DA  - 2026/11/02
JO  - Case reports in anesthesiology
DO  - 10.1155/cria/4477329
UR  - https://europepmc.org/article/MED/42974378
AB  - 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.
SN  - 2090-6382
SN  - 2090-6390
ER  -