Harlequin syndrom(syndrome)

    
      Re: Harlequin syndrom (syndrome)
    


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Posted by CCF Neurology MD on July 15, 1997 at 15:29:32:

In Reply to: Harlequin syndrom (syndrome) posted by Sheila Fillmroe on July 03, 1997 at 07:17:50:

: I have had numbness in my right hand and arm for approximately three years, brought on by exercise.  I didn't have it checked out until four months ago I noticed that when I exercise, the left half of my face turns red and the right side stays white.  I've been to a nueorlogist who sent me to a vascular surgeon, who ordered an MRI, MRA and various x-rays.  Results: rotator cuff tears and SLAP lesion, "diminished caliber and blood flow along an approximately 3 cm segment of subclavian artery lateral to the bifurcation of the right brachiocephalic artery", and the vascular surgeon says that I have "Harlequin's syndrome".  The surgeon said there is nothing to worry about, continue to exercise, and don't worry.  That's fine, but I have not been able to find any information about Harlequin's syndrome and I have no idea what to expect.  
=Dear Shelia, Harlequin Effect (or syndrome as used by the vascular surgeon) is seen with Horner Syndrome. It is the result of preganglionic
lesions of the sympathetic pathway to the face. As a result of these lesions, facial flushing occcours, which can be brought
upon by excercise in some instances. Horner syndrome is a dysfunction of the sympathetic innervation to one side of the face, neck and shoulder
region.  It presents on examination with miosis (small diameter pupil), ptosis (droopy eye-lid) and anhydrosis (lack of sweating). Most
commonly people present with miosis and ptosis. Most likely your vascular surgeon is using the phrase "harlequin syndrome" to describe only the
facial flushing/redness you see following excercise. Morever, in your case it may be of vascular and not neurological origin. I would recommend
discussing this with both the vascular surgeon and neurologist so that everyone is in agreement the "harlequin syndrome" observed is not of
neurological origin. If you wish a second opinion from another neurologist, I would recommend one of the neuromuscular neurologist
here at the CCF(Drs. Levin, Mitsumoto, Piro or Shields-444-5559). "This information is provided for general medical education purpose only.
Please consult your physician for diagnostic and treatment options of your specific medical condition."