Coexisting Harlequin and Horner's syndromes

Editor—We would like to correspond further with regardto the article entitled ‘Coexisting Harlequin and Horner'ssyndromes after high thoracic paravertebral anaesthesia’.¹² A combined technique of general anaesthesia and a thoracicparavertebral block was performed. In this case a well-demarcatedcontralateral hemifacial flushing and ipsilateral pallor developed,without the distinctive ipsilateral Horner's syndrome. After induction of general anaesthesia, a left paravertebralblock was performed at T3/T4 using a 20G spinal needle