Iatrogenic Horner syndrome following internal jugular vein catheterization in an infant: a case report and literature review.

Introduction: Horner syndrome (HS) is a rare but recognized complication of internal jugular vein (IJV) catheterization in children, resulting from injury to the cervical sympathetic pathway. Neonates and infants are particularly vulnerable due to the compact anatomy of the neck. Presentation of the case: We report a 38-day-old female infant who developed ipsilateral HS following open surgical placement of a Broviac catheter via the right IJV. The catheter was inserted under local anesthesia with sedation for prolonged intravenous therapy. Within 24 hours postoperatively, the patient presented with right-sided ptosis, miosis, and apparent enophthalmos, without any other neurological deficits. The diagnosis of iatrogenic HS was made based on the typical clinical features and the close temporal relationship with the procedure. Management consisted of close observation with serial neurological and ophthalmological examinations, and the catheter was left in place. Progressive improvement was noted within 48 hours, with complete resolution of symptoms by 1 week. Discussion: HS following IJV catheterization is uncommon in pediatric patients, with only a few cases reported in the literature. Although most cases occur after percutaneous cannulation, this complication may also arise after open surgical approaches, even under direct visualization. Proposed mechanisms include direct injury to the sympathetic chain, compression from a hematoma or edema, and ischemic neuropraxia. The prognosis is generally favorable, with spontaneous recovery in most cases. Conclusion: This case highlights that iatrogenic HS can occur after open surgical IJV catheterization in infants. Awareness of this rare complication, careful surgical technique, and prompt recognition are essential to ensure optimal outcomes.