Approach Considerations
As previously stated, because painful Horner syndrome can occur with other diseases, such as cluster headache and carotid dissection or aneurysm, a diagnosis of Raeder paratrigeminal syndrome should be made on clinical and radiologic grounds. [9]
Laboratory Studies
While most cases of Raeder paratrigeminal syndrome are benign, a thorough evaluation to exclude secondary causes may be warranted, particularly if parasellar nerve involvement is evident.
Basic laboratory analysis to evaluate for inflammatory or infectious etiologies also may be warranted.
A basic chemistry profile, a complete blood count (CBC), the erythrocyte sedimentation rate, antinuclear antibody, and rheumatoid factor may be helpful in screening for inflammatory or infectious causes.
Imaging Studies
The neurodiagnostic evaluation should include magnetic resonance imaging (MRI) and MR angiography (MRA) of the brain. These studies help to exclude secondary causes such as dissection, vascular anomaly, and aneurysm.
Cerebral arteriography may be considered if clinically indicated or if MRA findings warrant further evaluation.
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Cervical sympathetic pathway, including oculosympathetic fibers. A lesion at A would produce a complete Horner syndrome with ipsilateral loss of facial sweating; a lesion at B would produce oculosympathetic paresis, but with preserved facial sweating. Reprinted with permission (Hanley and Belfus, Inc. Academic Emergency Medicine 1996; 3(9); 864-867.)
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Evident in this patient are the mild ptosis of the left upper eyelid, the slight elevation of the left lower eyelid, and the miosis of the left eye. Reprinted with permission (Copyright American Society of Contemporary Ophthalmology. Annals of Ophthalmology 1978; 10(9); 1181-1187.)
