Clinical and Medical Case Reports

A Case Report on Reversible Horner’s Syndrome as a Complication of Left Internal Jugular Vein Catheterization

Abstract

Khalid Al-Matham, Fadel Al-Rowaie, Abdulaziz Al-Atmi and Lina Al-Sharif

Horner’s syndrome, characterized by clinical signs including ptosis, pupillary miosis resulting in anisocoria, and facial anhydrosis, is a rare ocular complication following internal jugular vein catheterization. We report a case occurring in a 23-year old female who developed acute left-sided Horner’s syndrome after uneventful insertion of a left-sided permanent dialysis catheter. Ultrasound revealed no evidence of hematoma or carotid dissection. The catheter was left in place, and her symptoms resolved completely after 2 days. Clinicians should be alert for Horner’s syndrome in these patients, to assure appropriate diagnosis, documentation, and follow-up are provided, aiming at greater understanding of risk factors for and potential consequences of this rare complication.
Establishing reliable vascular access is essential for successful hemodialysis in patients with end stage renal disease (ESRD). A cuffed, tunneled catheter (permacath) is often used for prolonged renal replacement therapy, with internal jugular vein access preferred due to its accessibility, low malposition rate, and overall low complication rate. However, up to 35% of internal jugular vein catheterization attempts across all indications may be unsuccessful, and complication rates up to 19% have been reported.
Horner’s syndrome is a rare ocular complication that may occur after internal jugular vein catheter insertion, which usually resolves spontaneously. Because of its rarity, only a paucity of information is available about its specific etiology and course. Additionally, Horner’s syndrome is considered to be underdiagnosed. Awareness of this condition is important to foster appropriate diagnosis, documentation, and follow-up for patients who develop its signs. Accordingly, we report a self-limiting case of Horner’s syndrome that developed after internal jugular vein permacath insertion, and compare it with other cases reported in the literature.