Raeder's syndrome. A clinical review

The diagnosis of Horner's syndrome (HS) can be difficult, as patients rarely present with the classic triad of ptosis, miosis, and anhydrosis. Frequently, there are no associated symptoms to help determine or localise the underlying pathology. The onset of anisocoria may also be uncertain, with many cases referred after incidental discovery on routine optometric assessment. Although the textbooks discuss the use of cocaine, apraclonidine, and hydroxyamphetamine to diagnose and localise HS, in addition to reported false positive and negative results, these pharmacological agents are rarely available during acute assessment or in general ophthalmic departments. Typically, a week is required between using cocaine or apraclonidine for diagnosis and localisation of HS with hydroxyamphetamine, leaving the clinician with the decision of which investigations to request and with what urgency. Modern imaging modalities have advanced significantly and become more readily available since many of the established management algorithms were written. We thus propose a practical and safe combined clinical and radiological diagnostic protocol for HS that can be applied in most clinical settings.

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“…Cluster headaches with associated signs of acute oculosympathetic palsy are seen in 5-22% of patients. 6,7 Challenges of the clinical examination…”

Section: Anatomical Localisation In Relation To Clinical Signsmentioning

confidence: 99%

Adult Horner’s syndrome: a combined clinical, pharmacological, and imaging algorithm

Davagnanam

Fraser

Miszkiel

et al. 2013

Eye

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“…Many of the cases reported since then did not conform to the clinical picture reported by Raeder. Moreover, some authors included cluster headache patients in this group, increasing the confusion concerning this clinical entity [3]. Therefore, RS is an unclear diagnosis and there are many authors who do not believe in its existence as an independent syndrome.…”

Section: Discussionmentioning

confidence: 99%

Dolichoectasia of the cavernous internal carotid artery: another cause for Raeder's syndrome

Morís¹,

Ribacoba²,

Solar³

et al. 2000

J Headache Pain

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A 38-year-old man presented with ptosis, miosis, facial pain and hypoesthesia in the ipsilateral ophthalmic division of the trigeminal nerve. Brain magnetic resonance imaging and magnetic resonance angiography showed fusiform dilation of the cavernous portion of the left carotid artery. A diagnosis of Raeder's syndrome (RS) was made. Carbamazepine selectively relieved the facial pain but the partial Horner syndrome persisted. Our case adds dolichoectasia of the intracavernous internal carotid artery to the list of causes of RS.

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“…The majority of Raeder's syndrome cases are due to carotid artery dissection (2,5,6,7,8). Only one of the 5 cases reported by Raeder himself was associated with a middle cranial fossa tumor (endothelioma) (2).…”

Section: Discussionmentioning

confidence: 99%