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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 1  |  Page : 94-96
Horner's syndrome following Internal Jugular Vein Dialysis Catheter Insertion

Department of Internal Medicine, Division of Nephrology, King Fahd Medical City, Riyadh, Kingdom of Saudi Arabia

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Common complications that can occur following internal jugular vein catheterization used for hemodialysis (HD) include internal carotid artery puncture, thrombosis, and infection. We present a case of Horner's syndrome following internal jugular venous cannulation as a possible complication.

Keywords: Horner Syndrome, internal jugular vein canulation, hemodialysis

How to cite this article:
Ahmad M, Hayat A. Horner's syndrome following Internal Jugular Vein Dialysis Catheter Insertion. Saudi J Kidney Dis Transpl 2008;19:94-6

How to cite this URL:
Ahmad M, Hayat A. Horner's syndrome following Internal Jugular Vein Dialysis Catheter Insertion. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2021 Oct 26];19:94-6. Available from: https://www.sjkdt.org/text.asp?2008/19/1/94/37443

   Introduction Top

Internal jugular vein (IJV) is the most common site used for insertion of hemodialysis catheters for vascular access due to its high success and low complication rates. The most common complications that can occur following IJV canulation include internal carotid artery (ICA) puncture, pneumothorax, vessel erosion, thrombosis, airway obstruction and infection. Usually, patients on hemodialysis have the tendency of developing repeated access failures and multiple recannulations. There is a high prevalence of venous thrombosis and stenosis in patients on long standing dialysis, which increases the risk of such complications. [1],[2],[3]

Here, we report a patient on hemodialysis who developed Horner's syndrome (HS) following right internal jugular vein cathe­terization.

   Case Report Top

A 17-year-old male from Yemen, a known case of chronic renal failure secondary to chronic glomerulonephritis on chronic hemo­dialysis thrice a week since August 2004 through left radio cephalic AV fistula.

In June 2005, when the patient presented for a routine session of hemodialysis, his AV fistula could not be used for dialysis because of a hematoma formation from previous cannulation. We inserted a tempo­rary right internal jugular vein catheter after multiple attempts. Following catheterization, X-ray chest was performed, which revealed a hematoma in the right side of the neck with slight tracheal compression. However, there was no hemo- or pneumothorax. The patient was dialyzed using this catheter and full dose heparin was administered. The patient was sent home in a stable condition after the dialysis. He presented for his next session of hemodialysis after three days, when he was noticed to have a ptosis right eyelid. According to the patient and his mother, he developed spontaneous uncontrolled tears of right eye, sagging of the right upper eyelid, swelling and pain in right eye, and decreased visual acuity immediately after the catheter insertion. He was examined by the neuro­logist who observed anisocoria (right pupil diameter 27 mm and left pupil diameter 46 mm), but reacting to light normally. Compu­terized tomography (CT) scan of neck and chest was performed, and was unremarkable. This constellation of symptoms and signs was consistent with Horner's syndrome due to injury of the sympathetic plexus. There was resolution of anisocoria and ptosis over a period of 4 weeks.

   Discussion Top

Horner's syndrome is one of the rare com­plications of the IJV catheterization. The more common complication that can occur following IJV catheterization include carotid artery aneurysm in 2-8% of cases, which can lead to hematoma formation with tracheal compression, AV fistula formation, pseudo­aneurysm, aortic dissection, and thrombosis following prolonged catheter use. Venous air embolism rarely occurs in patients with negative intrathoracic pressure or cathete­rization performed in a sitting position. Injury to the vagus nerve, hypoglossal nerve, stellate ganglia, and phrenic nerve can occur due to direct trauma or injection of local anesthesia.

HS occurs as a result of interruption of nerve fibers supplying the ocular muscles anywhere between its origin in the hypothalamus and the eye. The classic clinical signs associated with the Horner' syndrome include ptosis, miosis, anhidrosis and loss of ciliospinal reflex. Other signs that may be associated with this syndrome include defects in accommodation, heterochromia, reduced tear viscosity, transient decrease in the intraocular pressure and transient paradoxical eye lid retraction. [1],[2],[3],[4] The usual causes of acquired HS are trauma, aortic dissection, carotid dissec­tion, tuberculosis, Pancoast tumor, and epi­dural anesthesia injection. [4],[5],[7],[8] HS may also develop following excessive rotation of the head and neck during repeated attempts of cannulation of the internal jugular, causing alteration of the normal anatomical rela­tionship between the internal jugular vein and the sympathetic plexus. [1],[9],[10],[11] In our patient, we considered that HS was due to repeated attempts of IJV cannulation that caused local hematoma formation, in addition to probably excessive movement of head and neck.

In conclusion, HS should be recognized as one of the possible complications of percu­taneous hemodialysis catheterization via the internal jugular vein. Physicians should be aware of this complication and avoid repeated manipulations. Catheterization, whenever possible, should be performed under ultra­sound guidance.

   References Top

1.Taskapan H, Oymak O, Dogukan A, Utas C. Horner's Syndrome secondary to internal Jugular vein catheterization. Clin Nephrol 2001;56:78-80.  Back to cited text no. 1  [PUBMED]  
2.Reddy G, Coombes A, Hubbard AD. Horner's Syndrome following internal Jugular vein cannulation. Intensive Care Med 1998; 24:194-6  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Parikh AK. Horner's syndrome: A compli­cation of percutaneous catheterization of internal jugular vein. Anesthesia 1972; 27:327-9.  Back to cited text no. 3    
4.III. NKF-K/DOQI Clinical practice guidelines for the vascular access: Update 2000. Am J Kidney Dis 2001;37:S137-81.  Back to cited text no. 4  [PUBMED]  
5.Cimochowosky GE, Worley E, Rutherford WE, Sartain J, Blondin J, Harter H. Superiority of Internal Jugular over the Subclavian access for temporary hemo­dialysis. Nephron 1990;54:154-61.  Back to cited text no. 5    
6.Goldfrab G, Lebrec D. Percutaneous cannulation of the Internal Jugular vein in patients with coagulopathies. Anesthesiology 1982;56:321-3.  Back to cited text no. 6    
7.Vaswani S, Garvin L, Matuschak GM. Postganglionic Horner's syndrome after insertion of a pulmonary artery catheter through the internal jugular vein. Crit Care Med 1991;19:1215-6.  Back to cited text no. 7  [PUBMED]  
8.Teich SA, Halprin SL, Tay S. Horner's syndrome secondary to Swan Ganz cathe­terization. Am J Med 1985;78:168-70.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Ohlgisser M, Heifetz M. An injury of the Stellate Ganglion following introduction of a cannula into the IJ vein (Horner's syndrome). Anesthetist 1984;33:320-1.  Back to cited text no. 9    
10.Pither C. Horner's syndrome following internal jugular vein cannulation. Anesthesia 1983;38:171.  Back to cited text no. 10    
11.Lips U, Conrad I, Zevounou F, Schappler­Scheele B. Report of two cases of irreversible Horner's syndrome after puncture of the Internal Jugular vein. Anasth Intensivther Notfallmed 1982;17:301-2.  Back to cited text no. 11  [PUBMED]  

Correspondence Address:
Ashik Hayat
Clinical Fellow Nephrology, University Health Network, Toronto General Hospital, Canada M5B 2E8

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PMID: 18087133

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