Maranhão-Filho P A, Martins M A, Lopes H F
Department of Neurosurgery, National Cancer Institute, Rio de Janeiro, Brazil.
Arq Neuropsiquiatr. 1995 Dec;53(4):831-3. doi: 10.1590/s0004-282x1995000500022.
An unusual case of Horner'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 sign, 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 a right 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).
本文描述了一例慢性粘连性蛛网膜炎（CAA）患者因交感神经阻滞继发霍纳综合征的罕见病例。该患者为一名40岁的白人女性，自32岁起出现痉挛性截瘫、反射亢进、双侧巴宾斯基征、T4水平浅表和深部感觉减退，以及膀胱和直肠功能障碍。38岁时，她抱怨T4水平以下每日出汗过多，主要在夜间。进行了4mL 0.5%布比卡因腰交感神经阻滞。15分钟内，出现了右上肢轻瘫和同侧霍纳综合征。据推测，由于CAA继发的假定不规则间隙导致麻醉剂异常向头部扩散，即使使用相对少量的麻醉剂（4mL），也可能解释这种临床表现。
