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Acute postpartum Horner's syndrome due to epidural anesthesia.

Acute Horner's syndrome may reflect hypothalamic infarction, cervical spine dislocation, arterial dissection, and intracranial hemorrhage or mass lesion with increased intracranial pressure. 1,2 We report a case demonstrating an infrequent cause of acute Horner's syndrome: lumbar epidural obstetric anesthesia. Although several cases of acute Horner's syndrome following such epidural anesthesia use have been reported primarily in the anesthesiologic and obstetric literature, 1,3-6 the entity is, to our knowledge, unreported in the ophthalmologic and neurologic literature. Report of a Case. A 28-year-old woman complained of blurred vision in her left eye and left posterolateral neck pain 1 hour after a vaginal delivery. Her obstetrician noted left-sided ptosis and miosis. During labor, the patient had received 8 mL of 0.25% bupivacaine hydrochloride into the epidural space via an indwelling epidural catheter. The labor and delivery were uncomplicated except for maternal fatigue and insufficient pushing, resulting in vacuum-assisted vaginal delivery. The patient's medical