© 2003 Fellowship of Postgraduate Medicine
IMAGES IN MEDICINE
Iatrogenic harlequin syndrome
Hillingdon Vascular Unit, Hillingdon Hospital, Pield Heath Road, Uxbridge, Middlesex UB8 3NN, UK; marios@nicolaou.org
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Thoracoscopic sympathectomy is a safe, effective, minimally invasive treatment for primary hyperhidrosis.1
A 29 year old man with severe facial hyperhidrosis underwent an uncomplicated right thoracoscopic sympathectomy. Before operating on his left side, a starch-iodine preparation was applied to his face in order to demarcate residual sudomotor function. The preparation becomes blue on exposure to moisture, thereby representing residual sweat gland activity.
Figure 1
demonstrates that sympathetic innervation to the face is strictly unilateral, and nerve fibres do not appear to cross the midline. This is essentially an iatrogenic variation of the harlequin syndrome,2 which usually results from interruption of post-ganglionic sympathetic fibres secondary to malignant invasion.
[in a new window] Figure 1 Starch-iodine preparation applied to patient’s face (published with patient’s permission).
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His facial hyperhidrosis was completely treated once the contralateral sympathectomy was performed.
- Lin TS, Fang HY. Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis—with emphasis on perioperative management (1,360 case analyses). Surg Neurol 1999;52:453–7.[CrossRef][Medline]
- Montigiani A, Cencetti S, Bandinelli G, et al. The "harlequin sign". Case description and review of the literature. Ann Ital Med Int 1998;13:173–5.[Medline]
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