• Bryan Boling, Christopher Key, Justin Wainscott, and Annette Rebel.
• Bryan Boling is a staff nurse in the cardiothoracic vascular intensive care unit and a doctoral student in the acute care nurse practitioner program at the University of Kentucky, Lexington.Christopher Key is a staff anesthesiologist, Department of Anesthesiology, University of Alabama, Birmingham.Justin Wainscott is an attending physician on the acute pain service, Department of Anesthesiology, University of Kentucky.Annette Rebel is an attending physician on the critical care service, Department of Anesthesiology, and program director of the critical care fellowship program, University of Kentucky. bryanboling@uky.edu.
• Crit Care Nurse. 2014 Jun 1;34(3):57-61.

AbstractHarlequin syndrome is a rare neurological condition that results in unilateral facial flushing and sweating. Although the syndrome is generally a benign condition with complete resolution if appropriate treatment is initiated, unilateral facial flushing can be a sign of several serious conditions and should be thoroughly investigated. Sudden onset of facial flushing related to harlequin syndrome developed in a patient who had bilateral lung transplant with postoperative epidural anesthesia for pain control. Differential diagnosis includes neurovascular disease (acute stroke), malignant neoplasm of brain or lung, Horner syndrome, idiopathic hyperhidrosis, and Frey syndrome. Harlequin syndrome is often easily treated by discontinuing the anesthetic or adjusting placement of the epidural catheter.©2014 American Association of Critical-Care Nurses.

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