A 35-year-old man sent us this self-portrait, taken with a digital camera, showing significant asymmetric flushing on the left side of his face after jogging. The episode resolved spontaneously after 30 minutes of rest. Harlequin syndrome consists of flushing limited to one side of the face due to sympathetic disturbance on the contralateral side.1 Although most cases are benign, imaging and neurological examination should be performed in patients with this condition to rule out serious structural lesions of the sympathetic pathway, such as mediastinal neurinoma, spinal invasion by lung cancer and brainstem infarction.
- 1. Wasner G, Maag R, Ludwig J, et al. Harlequin syndrome — one face of many etiologies. Nat Clin Pract Neurol 2005; 1: 54-59.
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