# Delayed Presentation of Horner’s and Harlequin-Like Symptoms Following Interscalene Peripheral Nerve Catheter Placement

## TL;DR

A patient developed unusual Horner’s and Harlequin-like symptoms more than 36 hours after an interscalene nerve catheter was placed.

## Contribution

This case report highlights a delayed and combined presentation of complications from interscalene catheter migration.

## Key findings

- Symptoms appeared over 36 hours after catheter placement.
- Combined partial Horner’s and Harlequin-like syndromes were observed.
- This is the first reported case with such a delay and symptom combination.

## Abstract

Interscalene peripheral nerve catheters are a commonly performed procedure often used to provide continuous outpatient analgesia following orthopedic procedures. In this case report, we present an interesting case of a patient who received an interscalene catheter following an orthopedic procedure and demonstrated an atypical presentation of combined partial Horner’s and Harlequin-like syndromes evolving more than 36 hours after block placement. Although several case reports in the literature exist describing incidents in which interscalene catheter migration has led to the late onset of complications, it has never before been observed with either this degree of delay or this combination of symptoms. This case emphasizes the importance of recognizing irregular presentations of interscalene block complications secondary to catheter migration.