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Painful postganglionic Horner syndrome may be the initial presentation of an internal carotid artery (ICA) dissection and less frequently is a complication of cluster headache.1 However, it is not a frequent presentation of pituitary adenoma. We describe a patient with prolactinoma that initially manifested with painful Horner syndrome and improved on dopaminergic therapy. Eighteen months after treatment was discontinued, the patient sought treatment for a cavernous sinus syndrome that responded well to high-dose dopaminergic therapy.
Case report.
A 52-year-old man was examined by one of our staff neurologists for an intermittent right hemicrania, retro-orbital pain and a narrowed palpebral fissure in March 1999. He had no history of alcoholism, head trauma, hypertension, diabetes mellitus, chronic headaches, impotence, or decreased libido. He smokes one pack of cigarettes daily. Examination revealed a 2-mm ptosis of the right upper eyelid and a 2-mm pupil that failed to dilate in the dark and after hydroxyamphetamine. The left pupil, in contrast, …
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