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NEUROLOGY 2009;72:e44
© 2009 American Academy of Neurology
Resident and Fellow Section

Teaching Video NeuroImages: Recurrent oculomotor neuropathy with isolated ptosis vs ophthalmoplegic migraine

Formula

Lucas Martín Romano, MD and Ana Gabriela Besocke, MD

From the Neurology Department, Hospital Privado de Comunidad, Mar del Plata, Argentina.

Address correspondence and reprint requests to Dr. Lucas Martín Romano, Córdoba 4545, Neurology Department, Hospital Privado de Comunidad, Mar del Plata, ZC 7600, Argentina lromano{at}sna.org.ar

A 13-year-old girl presented with left-sided periorbital headache and homolateral ptosis with normal ocular motility and pupillary response (video segment 1 on the Neurology® Web site at www.neurology.org). She had a similar episode 1 year before. Brain MRI showed enhancement of the left oculomotor nerve (figure). She recovered completely within 7 days (video segment 2). Two months later, MRI was normal.


Figure 118
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  		Figure MRI showing gadolinium-enhanced T1-weighted image of the intracisternal portion of the oculomotor nerve with gadolinium

(A) Coronal image. (B) Sagittal image. (C) Axial image.

 

Ophthalmoplegic migraine is very rare. One similar report was identified in the literature.1

Differential diagnoses include neoplasm, aneurysm, carotid dissection, temporal arteritis, sarcoidosis, Tolosa-Hunt syndrome, and infectious etiologies.

Response to steroids and the reversible MRI contrast enhancement of the affected cranial nerve both point to an inflammatory mechanism rather than a migrainous condition, and introduce the possibility of reclassifying ophthalmoplegic migraine as a recurrent neuritis.2

Supplemental data at www.neurology.org

Disclosure: The authors report no disclosures.


   REFERENCES
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 REFERENCES
 

  1. Stidham DB, Butler IJ. Recurrent isolated ptosis in presumed ophthalmoplegic migraine of childhood. Ophthalmology 2000;107:1476–1478.[Medline]
  2. McMillan HJ, Keene DL, Jacob P, et al. Ophthalmoplegic migraine: inflammatory neuropathy with secondary migraine? Can J Neurol Sci 2007;34:349–355.[Medline]




This Article
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Right arrow Articles by Romano, L. M.
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PubMed
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Right arrow Articles by Romano, L. M.
Right arrow Articles by Besocke, A. G.
Related Collections
Right arrow Migraine
Right arrow Pediatric headache
Right arrow MRI
Right arrow Eyelids
Right arrow Cranial neuropathy

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