Recurrent Horner’s Syndrome and Cranial Nerve Involvement Following Epidural Analgesia During Labor: A Case Report

We report a rare case of a 33‐year‐old primigravida developing an extensive cephalad spread of epidural local anesthetic resulting in bilateral Horner’s syndrome and cranial nerve involvement during labor and cesarean delivery. Urgent neuroimaging excluded intracranial hemorrhage. Due to persistent focal neurological symptoms during second‐stage labor and inability to exclude a life‐threatening cerebrovascular pathology, cesarean delivery was performed for maternal indication. Following epidural top‐up for surgical anesthesia, symptoms recurred and progressed bilaterally, thereby supporting extensive cephalad spread as the underlying mechanism. Postpartum MRI and MR angiography revealed no cerebrovascular abnormalities. This case illustrates the diagnostic challenge of acute neurological symptoms during labor, where pregnancy‐associated stroke risk necessitates exclusion of life‐threatening pathology despite time constraints. Recognition of pregnancy‐related factors predisposing to extensive epidural spread, combined with interdisciplinary collaboration and appropriate neuroimaging, enabled safe management.