Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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March 14, 2016
Ophthalmoplegic Migraine
- Background:
- Ophthalmoplegic migraine or migrainous ophthalmoplegia is a type of cranial neuralgia.
- It is a poorly understood entity that involves recurrent episodes of headache with opthalmoplegia.
- The etiology is unclear but may involve acute bouts of nerve demyelination.
- Clinical Presentation:
- Episodes may be recurrent and may present with headache with ophthalmoplegia caused by involvement of cranial nerves III, IV, and VI. The oculomotor nerve is most commonly involved.
- Headaches may or may not be migraine-like.
- Predominantly affects the pediatric population and young adults
- Symptoms may last from hours-to-weeks or may be permanent.
- Key Diagnostic Features:
- Focal thickening and enhancement of the affected cranial nerve(s) on MRI is demonstrated.
- Typically, the root exit zone of the oculomotor nerve is affected. Both thickening and enhancement may persist, but enhancement usually diminishes or resolves.1
- Differential Diagnosis:
- Cranial nerve schwannoma/neuroma
- Lymphoma
- Sarcoidosis and other infiltrative cranial neuropathies
- Treatment:
- Symptoms may spontaneously resolve. Corticosteroid therapy has been reported to result in reduction in symptom duration and quicker recovery.
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