Abstract

Objective To report a rare case of Pourfour du Petit Syndrome (PDPS), presenting clinically as Subdural Block (SDB), as a complication of Obstetric Epidural Analgesia (OEA). PDPS is described as reverse Horner´s syndrome. It is characterized by mydriasis, exophthalmos, eye-lid retraction and hyperhidrosis. Case report A healthy 20-year-old woman in her second pregnancy, who requested OEA. A good analgesia was presented at the beginning. No problems were encountered during the procedure. Thirty minutes after the placement of the epidural catheter, she reported hypoesthesia in the lower limbs. One hundred and fifty minutes later she presented mydriasis in her left eye. She also presented a patchy spread of sensory and motor symptoms, as well as a block disproportionate to the amount of drug injected. She did not present any change in her consciousness level, ventilation or hemodynamic function as compared to baseline. Three hours after delivery the neuro-ophthalmic symptoms completely disappeared. In her previous pregnancy an OEA was requested too without any incidents. Conclusions 1) The awareness of clinical presentation of inadvertent SDB following OEA may assist in early diagnosis and adequate management to avoid potentially serious complications caused by sympathetic disorders. 2) The PDPS could be considered as a clinical presentation of subdural block.

Authors and Affiliations