Raeder's syndrome leading to a diagnosis of nasopharyngeal carcinoma

Raeder's syndrome or Raeder's paratrigeminal neuralgia is an uncommon neurological disorder characterized by pain, an ipsilateral oculosympathetic defect (ptosis and miosis), and ipsilateral trigeminal dysfunction. It is divided into two types. Type 1 has associated parasellar cranial nerve (III, IV, V, or VI) involvement, while type 2 does not.We report a 62-year-old patient who complained of diplopia, a left frontal headache, and narrowing of the fissure of the left eyelid. Partial abducens nerve palsy and anisocoria with left eye miosis were noted. Raeder's syndrome type 1 was considered and a parasellar lesion suspected. When a history of nasal stuffiness and epistaxis was reported, prompt otolaryngological consultation and computerized tomography were performed. A nasopharyngeal mass with cavernous sinus involvement was found. Cranial nerve abnormalities with oculosympathetic paresis in a patient with cluster headache (Raeder's paratrigeminal neuralgia, type 1) should alert the physician to a parasellar mass lesion, particularly to nasopharyngeal carcinoma in Chinese patients.