Be on the lookout for Harlequin ... known as a wily character, this disorder can be tricky to diagnose and determine an underlying cause

Over 26 yrs, 51 patients presented with Harlequin.

🔹median age 52
🔹76% women

Causes:
▶️17 % occurred as post-op complications

⏯️Other causes included: neoplasm, MS, trauma, small fiber neuropathy, pure autonomic failure, autoimmune

⏭️ causes was deemed idiopathic in 37%

First, what is Harlequin syndrome?

Unilateral facial anhidrosis leads to contralateral flushing and hyperhidrosis. While the flushed side is often concerning to the patient- the problem is the anhidrotic side which leads to compensatory sweating😓

TST: 🟣 sweating 🟡 is anhidrosis

In Clinical Autonomic Research:

pubmed.ncbi.nlm.nih.gov/40721556/

Curious about Harlequin syndrome- the neurologic disease named after the Italian theatrical performer from commedia dell'arte who is often depicted wearing a half mask?

The phenomenal Mayo med student Hannah Padilla shares new insights in Harlequin in our recent publication 🚨

Movement + Autonomics go together like...

Peanut butter and jelly 🥜
Chocolate and vanilla 🍦
Socks 🧦

Join us for the #movement #autonomic section showcase #AANAM @AANmember Sunday 3-4

See you in San Diego!

@DrISubramanian @PaulBeachDOPhD @amahajanmd.bsky.social

This 'pure' group is important.

It's a #synucleinopathy with autonomic involvement and many have central involvement (RBD) yet don't develop motor or cognitive impairment leading to #MSA #PD or #DLB

And many thanks to my amazing colleagues & mentors @MayoClinicNeuro

Timeline was interesting with most symptoms clustering around OH onset.

Median time to development of DEB was 7 years after OH but note the variability

In patients that remain PAF, most developed widespread autonomic failure... bladder, bowels, sexual and thermoregulatory dysfunction.

Dream enactment behavior was documented in 52% - likely an undercount due to the study timeline for PAF diagnosis (1998-2012)

Sometimes all that glitters is gold 💫

In thinking of PAF as a prodromal state, we miss that the majority of patients remain PAF during their lifetime.

This is an important group and we studied their clinical and autonomic profiles
🚨 Hot off the press #CAR

Congratulations to our Mayo Clinic Neurology Class of 2029! I can't get over these incredible future leaders in neurology 🌟 Happy Match Day everyone! #neuromatch

Louis-Bar was interesting. Despite a very productive start to an academic career and training under Ludo van Bogaert, she was seemingly an outcast from the scientific community.

Here are the ocular telangiectasia photos from Louis-Bar's original 1941 description.

B shows what was likely the first description of ataxia-telangiectasia syndrome in 1926 although Henner and Syllaba described a dystonic syndrome rather ataxia

In honor of National Women Physicians Day, one of my favorite Elizabeth Blackwell quotes:

"I wish I could devise some good way of maintaining myself but the restrictions which confine my dear sex render all my aspirations useless."

So grateful that she persevered