Hemicrania, Oculosympathetic Paresis, and Subcranial Carotid Aneurysm: Raeder's Paratrigeminal Syndrome (Group 2)

A 36-year-old white woman was asymptomatic until July 8, 1967, when she noted the gradual onset of left facial pain which resolved on the following day. She then developed burning, tearing, and redness of the left eye and drooping of the left upper eyelid. The ptosis persisted but the other ocular complaints abated during the next few days. On July 10 she had a constant intense sore on the left side which was unaffected by swallowing. She was able to relieve the throat discomfort by applying her index finger over the left palato-pharyngeal arch and pushing laterally and posteriorly. She also had pain over the left cranial vertex. For an entire day she had episodes of momentary, sharp, shooting pains which radiated inward through the left ear canal. Left supraorbital pain then occurred. She denied any asymmetry of facial sweating. The patient's past history was unremarkable except for high blood pressure since 1962. One week after the onset of her pains she was admitted to another hospital for angiographic studies. Daily doses of reserpine 0.1 mg, Hygroton 100 mg, and Vistaril 100 mg were prescribed. A left carotid arteriogram demonstrated an extracranial aneurysm arising from the left internal carotid artery near the base of the skull. A right ca-