Postoperative Horner’s syndrome following excision of incidental cervical ganglioneuroma during hemithyroidectomy and parathyroid gland exploration

This 49-year-old woman was referred to ear, nose and throat (ENT) with primary hyperparathyroidism. Imaging studies failed to localise the adenoma so she required four-gland parathyroid exploration. She also required diagnostic left hemithyroidectomy as she had a U3 nodule with multiple insufficient fine needle aspirations (FNAs). Intraoperatively, the left thyroidectomy proceeded uneventfully. No convincing left inferior parathyroid gland was identified however palpation revealed a 1 cm mass just medial to carotid artery. This was excised as probable ectopic parathyroid gland. She was discharged two days later. Thirteen days postoperatively she attended Eye Casualty with a left-sided Horner’s syndrome. A CT angio of aortic arch was normal. She was reviewed at ENT outpatients. Histopathology report of the expected ectopic parathyroid gland returned as benign ganglioneuroma, likely arising from her left sympathetic chain. Horner’s syndrome is a common side effect from excision of ganglioneuromas, but an incredibly rare side effect from thyroid or parathyroid surgery.

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Atypical presentation of subdural block resulting in Horner’s syndrome and loss of consciousness

BMJ Case Reports ◽

10.1136/bcr-2021-242622 ◽

2021 ◽

Vol 14 (9) ◽

pp. e242622

Author(s):

Katherine Jane Chua ◽

Maureen Cernadas

Keyword(s):

Intracranial Haemorrhage ◽

Spontaneous Resolution ◽

Neurological Deficits ◽

Horner’S Syndrome ◽

Horner's Syndrome ◽

Pupillary Reflex ◽

Epidural Catheter Placement ◽

Second Stage ◽

Rare Side Effect ◽

Ct And Mri

Horner’s syndrome is a rare side effect for patients receiving epidural anaesthesia. Studies described Horner’s syndrome due to cephalic spread of injected anaesthetics, a high spinal anaesthesia, or a sign of an inadvertent subdural block. A 31-year-old woman (Gravida 1 Para 0) at 40 weeks and 2 days had a caesarean section secondary to second stage arrest. Fourteen minutes after she received the lidocaine bolus, she became unresponsive with nystagmus, unequal pupils and no pupillary reflex. Head CT and MRI showed no intracranial haemorrhage and 2 hours later, she had spontaneous resolution of neurological symptoms with no further sequelae. Although Horner’s syndrome is a benign, transient process, clinicians should be mindful regarding epidural catheter placement causing subdural blocks resulting in spontaneous, reversible neurological deficits.

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Horner’s syndrome due to pancoast tumour

The Journal of Clinical and Scientific Research ◽

10.15380/2277-5706.jcsr.13.051 ◽

2014 ◽

Vol 3 (2) ◽

pp. 150

Author(s):

Alladi Mohan ◽

J Harikrishna ◽

BRaga Deepthi ◽

VArun Raja ◽

P Suneetha ◽

...

Keyword(s):

Horner’S Syndrome ◽

Horner's Syndrome

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May psychosis be a rare side-effect of sildenafil? A case-report

10.26226/morressier.5d1a037757558b317a1406ef ◽

2019 ◽

Author(s):

Mohammadreza Shalbafan ◽

Leila Kamalzadeh

Keyword(s):

Case Report ◽

Side Effect ◽

Rare Side Effect

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A genome-wide association study of nausea incidence in varenicline-treated cigarette smokers

Nicotine & Tobacco Research ◽

10.1093/ntr/ntab044 ◽

2021 ◽

Author(s):

Meghan J Chenoweth ◽

Caryn Lerman ◽

Jo Knight ◽

Rachel F Tyndale

Keyword(s):

Association Study ◽

Side Effect ◽

Genome Wide Association Study ◽

Genome Wide Association ◽

Common Side Effect ◽

Drug Transporter ◽

Transporter Gene ◽

Cigarette Smokers ◽

Genome Wide ◽

A Genome

Abstract Introduction Varenicline is the most efficacious smoking cessation treatment, however long-term cessation rates tend to be <25%. Nausea, the most common side effect of varenicline, observed in ~28% of individuals treated, peaks early following treatment initiation and reduces cessation success. Genetic variation influences treatment response, however genetic contributors to individual differences in side effects are less understood. Methods We conducted a genome-wide association study of nausea incidence at one week following the initiation of varenicline treatment (corresponding to the target quit date) in 189 cigarette smokers of European ancestry (NCT01314001). Additive genetic models examining the likelihood of experiencing any versus no nausea controlled for population substructure, age, and sex. Variants with minor allele frequencies (MAF) ≥ 10% were considered. Results Fifty-seven (30.2%) out of 189 participants reported nausea. The top variant associated with nausea was rs1568209 (OR=2.61 for A vs. G allele; 95% CI=1.65,4.15; P=2.1e-7; MAF=48.7%), mapping to the SLCO3A1 drug transporter gene on chromosome 15. In the same trial, rs1568209 was not associated with nausea in either the nicotine patch (P=0.56; n=181) or placebo (P=0.59; n=174) arms. In varenicline-treated smokers, the incidence of nausea was higher in females (44.6%; n=74) versus males (20.9%; n=115) (P=0.001), however there was no evidence of a difference in the influence of rs1568209 on nausea between the sexes (P for sex*genotype interaction=0.36). Future studies in larger samples are required to test the robustness of this finding. Conclusions Variation in SLCO3A1 may influence the risk for developing nausea in varenicline-treated smokers, which may alter adherence and cessation. Implications Varenicline-associated nausea reduces adherence and limits cessation success. Previous candidate gene association studies showed genetic factors influence nausea on varenicline. This pilot genome-wide investigation of nausea, the most common side effect associated with varenicline treatment and an importance cause of treatment discontinuation, suggests the potential involvement of common variation in the SLCO3A1 drug transporter gene.

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Clozapine-induced stuttering in the absence of known risk factors: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02803-8 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Florence Jaguga

Keyword(s):

Risk Factors ◽

Family History ◽

Side Effect ◽

Case Reports ◽

Extrapyramidal Symptoms ◽

Prior History ◽

Case Presentation ◽

Rare Side Effect ◽

History Of ◽

Electrophysiological Findings

Abstract Background Stuttering is a rare side effect of clozapine. It has been shown to occur in the presence of one or more factors such as abnormal electrophysiological findings and seizures, extrapyramidal symptoms, brain pathology, and a family history of stuttering. Few case reports have documented the occurrence of clozapine-induced stuttering in the absence of these risk factors. Case presentation A 29-year-old African male on clozapine for treatment-resistant schizophrenia presented with stuttering at a dosage of 400 mg/day that resolved with dose reduction. Electroencephalogram findings were normal, and there was no clinical evidence of seizures. The patient had no prior history or family history of stuttering, had a normal neurological examination, and showed no signs of extrapyramidal symptoms. Conclusion Clinicians ought to be aware of stuttering as a side effect of clozapine, even in the absence of known risk factors. Further research should investigate the pathophysiology of clozapine-induced stuttering.

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