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Magalhães LZA, Souza NAD. Case report recurrent painful ophthalmoplegic neuropathy. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2022.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Recurrent Painful Ophthalmoplegic Neuropathy (RPON) is a rare condition, previously known as Ophthalmoplegic Migraine, it is characterized by headache ipsilateral to paresis of the III, IV or VI cranial nerve, usually affects children or young adults. This is a report of a case of RPON in a 16-year-old woman treated at the Hospital do Servidor Público Estadual de São Paulo.
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Falsaperla R, Presti S, Lo Bianco M, Catanzaro S, Marino S, Ruggieri M. Diagnostic controversies in recurrent painful ophthalmoplegic neuropathy: single case report with a systematic review. Ital J Pediatr 2022; 48:82. [PMID: 35659705 PMCID: PMC9164546 DOI: 10.1186/s13052-022-01274-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ophthalmoplegic migraine, renamed "Recurrent Painful Ophthalmoplegic Neuropathy" (RPON) in 2013 by the International Headache Society is a rare neurologic disorder characterized by recurrent attacks of ophthalmoplegia associated to ipsilateral headache. The etiology is still unknown. Typical magnetic resonance imaging findings show a focal nerve thickening and contrast enhancement. In the majority of cases, there is a full recovery within days or weeks. There is no evidence supporting a specific treatment. The review defines the characteristics of the recurrent painful ophthalmoplegic neuropathy in patients within 2 years of age underlying the importance of the role of magnetic resonance imaging even in presence of the first attack. Thus, an emblematic case report is presented. Case presentation The authors present a case of third cranial nerve paresis in a 17-month-old male child, presenting a neuroradiological pattern highly suggestive of schwannoma, aneurism or recurrent painful ophthalmoplegic neuropathy. Thus, a review of the literature with the pediatric casuistry of recurrent painful ophthalmoplegic neuropathy occurred within 2 years of age focusing on diagnostic considerations is presented. The authors highlight the importance to consider recurrent painful ophthalmoplegic neuropathy in presence of magnetic resonance imaging findings and clinical symptoms referable to aneurysm or schwannoma. Thus, the review defines the characteristics and the neuroradiological findings at the first RPON attack occurred under 2 years of age. Conclusion Although two attacks are necessary, the review strongly suggests to consider recurrent painful ophthalmoplegic neuropathy even at the first attack, in presence of described characteristics and the aforementioned magnetic resonance imaging findings.
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Affiliation(s)
- Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, University Hospital "Policlinico Rodolico-San Marco", Catania, Italy.,Unit of Neonatal Intensive Care and Neonatology, University Hospital "Policlinico Rodolico-San Marco", Catania, Italy
| | - Santiago Presti
- Department of Clinical and Experimental Medicine, Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy.
| | - Manuela Lo Bianco
- Department of Clinical and Experimental Medicine, Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | | | - Silvia Marino
- Unit of Pediatrics and Pediatric Emergency, University Hospital "Policlinico Rodolico-San Marco", Catania, Italy
| | - Martino Ruggieri
- Department of Clinical and Experimental Medicine, Unit of Rare Diseases of the Nervous System in Childhood, Section of Paediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
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3
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Danni multipli dei nervi cranici. Neurologia 2022. [DOI: 10.1016/s1634-7072(21)46000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Oculomotor Nerve Palsy. Neuroophthalmology 2022. [DOI: 10.1007/978-981-19-4668-4_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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A Clinical Retrospective Study of Recurrent Painful Ophthalmoplegic Neuropathy in Adults. J Ophthalmol 2021; 2021:9213852. [PMID: 34956672 PMCID: PMC8709773 DOI: 10.1155/2021/9213852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/15/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Recurrent painful ophthalmoplegic neuropathy (RPON) is quite rare and usually occurs in children. In this report, we describe the clinical features, diagnosis, and treatment of RPON in adults. Methods A retrospective review was conducted of all RPON cases seen and treated at the Zhongshan Ophthalmic Center of Sun Yat-sen University and the Department of Neurology of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, over the period from January 2016 to May 2020. Results A total of 8 patients (3 males and 5 females) with a mean age of 42.9 years (range: 23–64 years) met the diagnostic criteria of RPON. Headaches were present prior to the onset of ophthalmoplegic neuropathy in 50% of these patients, while in the remaining 50%, headaches occurred simultaneously with eye symptoms. The degree of these headaches was described as being mild or moderate. Abnormalities involving cranial nerve III were the most frequently reported pathologies (6 cases, 75%), followed by nerve VI (4 cases, 50%) and then nerve IV (1 case, 12.5%) (more than one nerve was affected in some cases). Following either with glucocorticoid treatment or with observation only, symptoms and signs within all 8 patients completely dissipated within 3–28 days. Conclusions All adult cases of RPON along with their clinical features as reported here were similar to those of children.
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Nandana J, Nair SS, Girdhar S, Sundaram S. Recurrent painful ophthalmoplegic neuropathy: a cause for recurrent third nerve palsy in a child. BMJ Case Rep 2021; 14:e246179. [PMID: 34764123 PMCID: PMC8587473 DOI: 10.1136/bcr-2021-246179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 11/04/2022] Open
Abstract
Recurrent painful ophthalmoplegic neuropathy (RPON), previously called ophthalmoplegic migraine, is a rare condition characterised by recurrent episodes of headache and ophthalmoplegia. We report a case of 11-year-old girl with recurrent painful ophthalmoplegia due to isolated right oculomotor nerve involvement. MR brain imaging showed enhancing lesion of cisternal segment of right oculomotor nerve. A possibility of Tolosa Hunt syndrome was considered and she was treated with glucocorticoids, followed by azathioprine due to recurrence. In the fourth episode, she developed migraine headache followed by right third nerve palsy, after which the diagnosis was revised to RPON. She was started on flunarizine along with short-term glucocorticoids. At 1-year follow-up, she remained asymptomatic. RPON should be considered in patients with recurrent third nerve palsy to avoid inadvertent long-term exposure to immunosuppressive agents.
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Affiliation(s)
- Jayakumari Nandana
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Sruthi S Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Sachin Girdhar
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Soumya Sundaram
- Pediatric Neurology and Neurodevelopmental disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
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Thu PW, Chen YM, Liu WM. Recurrent Tolosa-Hunt syndrome. Tzu Chi Med J 2021; 33:314-316. [PMID: 34386372 PMCID: PMC8323652 DOI: 10.4103/tcmj.tcmj_137_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/29/2020] [Accepted: 07/15/2020] [Indexed: 11/06/2022] Open
Abstract
The Tolosa–Hunt syndrome (THS) is caused by granulomatous inflammation in the cavernous sinus, superior orbital fissure, or orbit characterized by painful ophthalmoplegia. Here, we report a case of recurrent THS in a 48-year-old female, who initially showed a poor response to low-dose steroids. Each episode involved different cranial nerves and painful ophthalmoplegia. Neuroimaging showed enhancement in the right cavernous sinus. The patient was treated with glucocorticoid pulse therapy and azathioprine. THS was previously considered to be responsive to glucocorticoids. This report demonstrates a case of THS with poor response to steroids and unique presentation of frequent recurrence with different cranial nerve involvement.
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Affiliation(s)
- Phyo-Wai Thu
- Department of Neurology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yu-Ming Chen
- Department of Neurology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Weng-Ming Liu
- Department of Neurology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Doctoral Degree Program in Translational Medicine, Tzu Chi University and Academia Sinica, Hualien, Taiwan
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Yokoyama T, Yamamiya M, Takakuwa M, Taniguchi C, Koizumi E, Jinkawa A, Obata M, Miyashita K, Inoue M, Sakazume S, Ohta K. Recurrent painful ophthalmoplegic neuropathy. J Paediatr Child Health 2021; 57:1303-1304. [PMID: 32870577 DOI: 10.1111/jpc.15147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/19/2020] [Accepted: 08/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Tadafumi Yokoyama
- Department of Pediatrics, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan.,Department of Pediatrics, Kanazawa University, Kanazawa, Japan
| | - Mari Yamamiya
- Department of Pediatrics, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Maiko Takakuwa
- Department of Pediatrics, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Chihiro Taniguchi
- Department of Pediatrics, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Eiko Koizumi
- Department of Pediatrics, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Asumi Jinkawa
- Department of Pediatrics, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Misato Obata
- Department of Pediatrics, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Kengo Miyashita
- Department of Pediatrics, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Mika Inoue
- Department of Pediatrics, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Shinobu Sakazume
- Department of Pediatrics, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Kazuhide Ohta
- Department of Pediatrics, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
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Prakash S, Prakash A, Lodha D. Bilateral persistent ophthalmoplegia in a patient with migraine: persistent migraine aura without infarction? BMJ Case Rep 2021; 14:14/4/e242099. [PMID: 33827884 PMCID: PMC8030678 DOI: 10.1136/bcr-2021-242099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Migraine auras typically last for 5-60 min. An aura that persists for more than a week without evidence of infarction on neuroimaging is called persistent aura without infarction. Persistent migraine aura without infarction is usually described with visual auras. Herein, we are reporting a 24-year-old man who had an attack of a headache with diplopia, vertigo and tinnitus. Tinnitus and vertigo disappeared within 30 min. The headache also disappeared within 6 hours. However, diplopia and ophthalmoplegia persisted for 4 weeks. Secondary causes of bilateral ophthalmoplegia were ruled out by a proper history, clinical examinations and appropriate investigations. A trial with lamotrigine and sodium valproate led to the complete improvement in ophthalmoplegia within 2 weeks. We considered ophthalmoplegia in this patient as 'persistent brainstem aura without infarction'. We suggest that a possibility of persistent migraine aura without infarction should be considered in all migraineurs who have unexplained and persistent neurological symptoms.
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Affiliation(s)
- Sanjay Prakash
- Neurology, SBKS Medical Institute and Research Centre, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Anurag Prakash
- Parul University Parul Institute of Medical Sciences and Research, Vadodara, Gujarat, India
| | - Deepali Lodha
- Department of Medicine, Smt BK Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Waghodia, Gujarat, India
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Recurrent alternating ophthalmoplegia with ipsilateral headache: unusual but possible manifestation of recurrent painful ophthalmoplegic neuropathy. Neurol Sci 2020; 41:3357-3360. [DOI: 10.1007/s10072-020-04502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/30/2020] [Indexed: 10/24/2022]
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Liu Y, Wang M, Bian X, Qiu E, Han X, Dong Z, Yu S. Proposed modified diagnostic criteria for recurrent painful ophthalmoplegic neuropathy: Five case reports and literature review. Cephalalgia 2020; 40:1657-1670. [PMID: 32722935 DOI: 10.1177/0333102420944872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Recurrent painful ophthalmoplegic neuropathy (RPON) is an uncommon disorder characterized by recurrent unilateral headache attacks associated with ipsilateral ophthalmoplegia. We intend to study the clinical picture in our case series along with the published literature to discuss the pathogenesis and propose modified diagnostic criteria for recurrent painful ophthalmoplegic neuropathy. Methods We reported five cases diagnosed as ophthalmoplegic migraine/RPON in our medical centers and reviewed the published literature related to RPON from the Pubmed database between 2000 and 2020. In one of these cases, a multiplanar reformation was performed to look at the aberrant cranial nerve. Results The mean onset age for RPON was 22.1 years, and the oculomotor nerve was the most commonly involved cranial nerve (53.9%) in 165 reviewed patients. In most patients, ophthalmoplegia started within 1 week of the headache attack (95.7%, 67/70). Additionally, 27.6% (40/145) of patients presented enhancement of the involved nerve(s) from MRI tests. Finally, 78 patients received corticosteroids, out of which 96.2% benefited from them. Conclusion This is the first time multiplanar reformation has been performed to reveal the distortion of the oculomotor nerve. Modified diagnostic criteria are proposed. We hope to expand the current knowledge and increase the detection of recurrent painful ophthalmoplegic neuropathy in the future.
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Affiliation(s)
- Yinglu Liu
- Medical School of Chinese PLA and Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Miao Wang
- Geriatric Neurological Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiangbing Bian
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Enchao Qiu
- Department of Neurology, The Fourth Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Xun Han
- Medical School of Chinese PLA and Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhao Dong
- Medical School of Chinese PLA and Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Shengyuan Yu
- Medical School of Chinese PLA and Department of Neurology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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Takemoto D, Ohkubo S, Udagawa S, Kuroda M, Sugiyama K. A Case of Recurrent Painful Ophthalmoplegic Neuropathy Successfully Treated with Beta-blocker Eye Drop Instillation. Neuroophthalmology 2020; 45:320-323. [PMID: 34483410 PMCID: PMC8409776 DOI: 10.1080/01658107.2020.1791190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
Recurrent painful ophthalmoplegic neuropathy (RPON) is a rare disorder, which typically occurs in children, and causes headaches and unilateral oculomotor palsy. Early high-dose corticosteroid therapy is recommended to rapidly resolve acute episodes. However, the pathophysiology and therapeutic options for this disorder remain to be fully elucidated. We report a case with typical clinical features of RPON successfully treated with beta-blocker eye drop instillation after the effects of high-dose corticosteroid and other therapies were not sufficient. We propose that beta-blocker eye drop instillation should be considered for patients with corticosteroid-resistant RPON.
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Affiliation(s)
- Daisuke Takemoto
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Shinji Ohkubo
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
- Ohukubo Eye Clinic, Kanazawa, Japan
| | - Sachiko Udagawa
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Mondo Kuroda
- Department of Pediatrics, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kazuhisa Sugiyama
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Recurrent Painful Ophthalmoplegic Neuropathy and Oculomotor Nerve Schwannoma: A Pediatric Case Report with Long-Term MRI Follow-Up and Literature Review. Pain Res Manag 2019; 2019:5392945. [PMID: 31662812 PMCID: PMC6778936 DOI: 10.1155/2019/5392945] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/09/2019] [Indexed: 01/03/2023]
Abstract
Background Recurrent painful ophthalmoplegic neuropathy (RPON), previously known as ophthalmoplegic migraine (OM), is an uncommon disorder with repeated episodes of ocular cranial nerve neuropathy associated with ipsilateral headache. The age of presentation is most often during childhood or adolescence. MRI has a central role in the assessment of the RPON, especially to distinguish orbital, parasellar, or posterior fossa lesions that mimic symptoms of RPON. Actually, oculomotor nerve tumors may be masquerade as RPON so that MRI follow-ups are required to detect the possibility of tumor etiology. Case presentation We report a 16-year-old boy with a 7-year follow-up and multiple brain MRI data, previously diagnosed as OM. The last brain MRI, performed during an acute phase of oculomotor paresis with ipsilateral headache, showed a nodular lesion described as schwannoma of III cranial nerve. Then, we reviewed the literature on OM and RPON in pediatric age with a focus on brain MRI findings. Conclusions This review highlights the important role of serial brain MRIs in the long-term follow-up of RPON, especially in the cases with childhood onset, in order to not delay the diagnosis of a possible oculomotor nerve schwannoma.
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Lal V, Caplan L. Are some ophthalmoplegias migrainous in origin? Neurol Clin Pract 2019; 9:256-262. [PMID: 31341714 DOI: 10.1212/cpj.0000000000000653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/14/2019] [Indexed: 11/15/2022]
Abstract
The 3rd edition of the International Classification of Headache Disorders replaced the term ophthalmoplegic migraine (OM) with Recurrent Painful Ophthalmoplegic Neuropathy (RPON) based on the presence of contrast enhancement of the involved cranial nerves on Gadolinium-enhanced magnetic resonance imaging. We review our experience and publications concerning ophthalmoplegia, migraine, and RPON. Majority of cases of acute ophthalmoplegia are associated with severe migrainous headaches. A positive history of migraine, increased severity of migraine headaches before the onset of ophthalmoplegia, and the close temporal association between migraine attacks and ophthalmoplegia all suggest an important role played by migraine in the causation of ophthalmoplegia. Enhancement of the involved cranial nerves may be due to the neuro-inflammatory cascade associated with migraine. OM should be considered along with RPON in differential diagnoses of painful ophthalmoplegic syndromes.
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Affiliation(s)
- Vivek Lal
- Department of Neurology (VL), Postgraduate Institute of Medical Education and Research, Chandigarh, India; Beth Israel Deaconess Medical Center (LC); and Department of Neurology (LC), Harvard University, Boston, MA
| | - Louis Caplan
- Department of Neurology (VL), Postgraduate Institute of Medical Education and Research, Chandigarh, India; Beth Israel Deaconess Medical Center (LC); and Department of Neurology (LC), Harvard University, Boston, MA
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Sreedhar A, Menon A. Understanding and evaluating diplopia. KERALA JOURNAL OF OPHTHALMOLOGY 2019. [DOI: 10.4103/kjo.kjo_57_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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