• Yasuko Nagasaka, Gunnar Wasner, Balram Sharma, and Katharine Fleischmann.
• From the *Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; †Neurological Outpatient Center, Christian Albrechts University, Kiel, Germany; and ‡Anesthesiology, Lahey Hospital and Medical Center, Burlington, Massachusetts.
• A A Case Rep. 2016 Feb 1; 6 (3): 48-51.

AbstractHarlequin syndrome is characterized by the sudden onset of unilateral facial flushing and sweating, often preceded by exercise, excessive heat, or, rarely, regional anesthesia. Although the exact mechanism remains unclear, it is often referred to as transient or permanent interruption of the sympathetic nervous system. We present a case of Harlequin syndrome without Horner syndrome in a patient with unilateral right-sided facial flushing that started shortly after a left-sided thoracic paravertebral nerve block for a mastectomy. We discuss the interruption of the sympathetic and parasympathetic nervous system and the levels of spinal nerve block associated with a thoracic paravertebral nerve block.

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