Raeder syndrome produced by extension of chronic inflammation to the internal carotid artery

Abstract

Presents the case reports of a 51-year-old man and a 78-year-old woman. Man noted a sensation of right ear fullness and vertigo; neurologic examination and brain MRI scan was normal. Three months later, he developed right-sided otitis media, right facial numbness, stabbing headaches, and intermittent drooping of the right eyelid. Examination revealed a partial Horner syndrome and right-sided trigeminal-distribution hypalgesia. CT angiogram showed no evidence of carotid artery dissection. The patient was treated with IV vancomycin 1 g twice daily for 3 days and piperacillin/tazobactam 3.375 g 4 times daily for 3 days, followed by oral doxycycline 100 mg twice daily and levofloxacin 720 mg daily for 5 weeks, as well as prednisone 60 mg for 3 days, 40 mg for 3 days, 20 mg for 3 days, and 10 mg for 3 days. Three months later, headaches and trigeminal-distribution hypalgesia had resolved, although the partial Horner syndrome was still evident. woman with long-standing subcortical arteriosclerotic encephalopathy complained of pain over the left zygoma for 7 years. Neurologic examination revealed severe dementia and gait ataxia. There was a partial left Horner syndrome and hypalgesia in the maxillary distribution of the left trigeminal nerve. In addition to brain atrophy and ischemic small artery disease, an air-fluid level and inflammatory changes consistent with a left maxillary sinusitis was revealed by brain CT. The presence of a pacemaker precluded MRI. Herein, brain imaging in 2 cases of Raeder syndrome revealed chronic mastoiditis and sinusitis, respectively. The outcomes after antibiotic treatment were favorable, with both patients experiencing considerable relief of pain and loss of facial hypalgesia. Furthermore, the Horner syndrome completely disappeared in the second patient although not in the first patient, perhaps due to permanent damage to sympathetic nerve fibers around the carotid artery. (PsycINFO Database Record (c) 2012 APA, all rights reserved)