Persistent Horner Syndrome Following Benign Gynaecological Surgery: A Case Report and Review of the Literature

Abstract

Horner syndrome is an uncommon neurological disorder resulting from the disruption of the oculosympathetic pathway and classically presents with ipsilateral ptosis, miosis and, variably, facial anhidrosis. Although recognised following cervical, thoracic and vascular procedures, it is rarely reported following benign gynaecological surgery. We present the case of a 44-year-old woman who developed persistent right-sided Horner syndrome following elective subtotal abdominal hysterectomy with bilateral salpingectomy performed under general anaesthesia with spinal anaesthesia. Right-sided ptosis developed on the first postoperative day and was followed by anisocoria without headache, neck pain, visual disturbance or diplopia. Horner syndrome was confirmed by apraclonidine testing. Extensive neurovascular investigations, including computed tomography (CT), CT angiography and magnetic resonance imaging (MRI), excluded intracranial, cervical and vascular pathology. Following multidisciplinary review, perioperative sympathetic chain injury related to neuraxial anaesthesia or patient positioning was considered the most likely explanation. Symptoms persisted at six months despite normal imaging. This case highlights the importance of recognising Horner syndrome after non-cervical surgery, promptly excluding life-threatening causes and considering perioperative sympathetic dysfunction as a diagnosis of exclusion.