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Aljammaz AM, Al Orainni H, Alnughaythir AI. Recurrent Painful Ophthalmoplegic Neuropathy Responding to Lamotrigine: A Case Report. Cureus 2024; 16:e56924. [PMID: 38665741 PMCID: PMC11044082 DOI: 10.7759/cureus.56924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Recurrent painful ophthalmoplegic neuropathy (RPON) is a rare neurological disorder characterized by recurring ipsilateral headache and paresis of one or more ocular motor nerves. We report the case of a 56-year-old woman with systemic lupus erythematosus (SLE) and hypertension, who presented with severe recurring headaches, nausea, and vomiting. Initially misdiagnosed with cerebral venous sinus thrombosis, her symptoms persisted despite anticoagulant therapy. Further evaluation led to the diagnosis of RPON. Management included intravenous analgesia, hydration, and indomethacin for pain relief. Persistent headache episodes necessitated the introduction of lamotrigine, resulting in significant symptom improvement. However, discontinuation of lamotrigine led to a recurrence of symptoms, which resolved upon resuming the medication. This case contributes to the limited RPON literature, providing insights into its diagnosis and management, with the goal of enhancing awareness and improving patient care.
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Affiliation(s)
- Ahmed M Aljammaz
- Vascular Neurology, Medical Cities Program, Ministry of Interior, Riyadh, SAU
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2
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Oluwole OJ, Khan Z, Crespo Cuevas AM, Lorente Miranda A, Iantorno V. Recurrent Headache With Diplopia: A Common Presentation of an Uncommon Entity. Cureus 2024; 16:e56183. [PMID: 38618429 PMCID: PMC11015942 DOI: 10.7759/cureus.56183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/16/2024] Open
Abstract
Recurrent painful ophthalmoplegic neuropathy (RPON) is a rare headache syndrome, the diagnosis of which can be daunting to those who are not familiar with it. It presents characteristically with recurrent ocular motor weakness and ipsilateral head pain without an underlying etiology and often has unique imaging findings. Even after the successful diagnosis of this entity, there are no published management guidelines. Here, we present the case of a 31-year-old man whom we diagnosed with RPON following two episodes of unilateral headache with ophthalmoplegia over a three-month period and treated successfully with high-dose steroids on both occasions. We highlight the lack of prior migraine history and seeming antecedent viral infection as potential supporting evidence that this condition has a unique pathophysiology different from migraine. We also highlight his dramatic and reproducible response to steroids as additional evidence that steroids are good acute treatment options for this condition. Finally, as our patient lacked the expected cranial nerve imaging abnormalities on head MRI, we suggest that cranial nerve thickening and/or enhancement on MR imaging is not a sine qua non for this diagnosis, contrary to the opinion of some experts.
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Affiliation(s)
| | - Zeeshan Khan
- Internal Medicine, King's College Hospital, Dubai, ARE
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3
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Koo H, Tsai K, Lee C, Mustafa I. A Case of Adult-Onset Recurrent Painful Ophthalmoplegic Neuropathy With Bilateral Ophthalmoplegia. Cureus 2024; 16:e54683. [PMID: 38523969 PMCID: PMC10960561 DOI: 10.7759/cureus.54683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Recurrent painful ophthalmoplegic neuropathy (RPON), previously known as ophthalmoplegic migraine, is a disorder typically characterized by recurrent episodes of unilateral headache concurrent with ipsilateral ocular cranial nerve paresis which primarily affects children. Diagnosis is mostly one of exclusion, based on clinical symptoms, supplemented by imaging for enhanced or distorted oculomotor nerves. We present a case of RPON in a 24-year-old adult female with unique features of unilateral left headache with ipsilateral pupillary dilation spreading to bilateral dilation and no MRI findings of oculomotor nerve enhancement.
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Affiliation(s)
- Hyunji Koo
- Neurology, Carle Illinois College of Medicine, Urbana, USA
| | - Katie Tsai
- Neurology, Carle Illinois College of Medicine, Urbana, USA
| | - Claire Lee
- Neurology, Carle Illinois College of Medicine, Urbana, USA
| | - Ibrahim Mustafa
- Neurology, Carle Illinois College of Medicine, Urbana, USA
- Neurology, Carle BroMenn Medical Center, Normal, USA
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4
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Azzarà A, Cassano I, Lintas C, Bernardini L, Pilato F, Capone F, Di Lazzaro V, Gurrieri F. A new gene for autosomal dominant facial palsy/migraine identified in a family by whole exome sequencing. Eur J Neurol 2024; 31:e16088. [PMID: 37823721 DOI: 10.1111/ene.16088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Facial palsy manifests as unilateral or bilateral weakness and inability to move some of the facial muscles. The aetiology may be different including idiopathic, trauma, infections or brain tumours or it can be associated with chronic neurological diseases. For instance, in recurrent migraine, an increased risk of idiopathic facial palsy (often unilateral) has been observed. Migraine is a neurovascular disorder characterized by mild to severe intensity of headaches, often associated with neuro-ophthalmological symptoms. METHODS A family is reported where five members were affected by facial palsy associated with other clinical features including migraine, diplopia, facial swelling, eye conjunctivitis following a vertical transmission. Whole exome sequencing was performed in three members (two affected and one healthy) in order to identify potential variants causative of their phenotype. RESULTS A missense variant c.304G>A was found leading to the p.(Ala102Thr) substitution in the TRPM8 gene, previously related to migraine by genome wide association studies. This variant was classified as deleterious by several predictor tools, and the mutant residue was predicted to alter the protein structure in terms of flexibility and interactions with the surrounding residues. CONCLUSION These findings suggest that TRPM8 could be a new causative gene further linking migraine and recurrent facial palsy.
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Affiliation(s)
- Alessia Azzarà
- Research Unit of Medical Genetics, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Ilaria Cassano
- Research Unit of Medical Genetics, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Carla Lintas
- Research Unit of Medical Genetics, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Operative Research Unit of Medical Genetics, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Fabio Pilato
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Fioravante Capone
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Fiorella Gurrieri
- Research Unit of Medical Genetics, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Operative Research Unit of Medical Genetics, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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5
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Moltoni G, Romano A, Blandino A, Palizzi S, Romano A, D'Arrigo B, Guarnera A, Dellepiane F, Frezza V, Gagliardo O, Tari Capone F, Grossi A, Trasimeni G, Bozzao A. Extra-axial cranial nerve enhancement: a pattern-based approach. LA RADIOLOGIA MEDICA 2024; 129:118-132. [PMID: 37882918 PMCID: PMC10808254 DOI: 10.1007/s11547-023-01734-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
Cranial nerve enhancement is a common and challenging MRI finding that requires a meticulous and systematic evaluation to identify the correct diagnosis. Literature mainly describes the various pathologies with the associated clinic-radiological characteristics, while the radiologist often needs a reverse approach that starts from the radiological findings to reach the diagnosis. Therefore, our aim is to provide a new and practical pattern-based approach to cranial nerve enhancement, which starts from the radiological findings and follows pattern-driven pipelines to navigate through multiple differential diagnoses, guiding the radiologist to reach the proper diagnosis. Firstly, we reviewed the literature and identified four patterns to categorize the main pathologies presenting with cranial nerve enhancement: unilateral linear pattern, bilateral linear pattern, unilateral thickened pattern, and bilateral thickened pattern. For each pattern, we describe the underlying pathogenic origin, and the main radiological features are displayed through high-quality MRI images and illustrative panels. A suggested MRI protocol for studying cranial nerve enhancement is also provided. In conclusion, our approach for cranial nerve enhancement aims to be an easy tool immediately applicable to clinical practice for converting challenging findings into specific pathological patterns.
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Affiliation(s)
- Giulia Moltoni
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy.
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy.
| | - Andrea Romano
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Antonella Blandino
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Serena Palizzi
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Allegra Romano
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | | | - Alessia Guarnera
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - Francesco Dellepiane
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - Valentina Frezza
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Olga Gagliardo
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Francesca Tari Capone
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Andrea Grossi
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Guido Trasimeni
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
| | - Alessandro Bozzao
- NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Via di Grottarossa, 00135, Rome, Italy
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6
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Gaul C, Fan W, Heindl LM, Jürgens T. [Differential diagnostics of chronic eye pain from a neurological perspective-What can also lie behind it]. DIE OPHTHALMOLOGIE 2023; 120:1226-1232. [PMID: 37999753 DOI: 10.1007/s00347-023-01958-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Periorbital pain and pain in the eye may arise from nociceptive processes such as chronic ocular surface destruction and inflammation, from neuropathic processes or often from a combination of different mechanisms. An important differential diagnosis are primary headache disorders and other neurological diseases, for example of inflammatory origin, which trigger secondary pain. Chronic eye pain therefore requires interdisciplinary collaboration in the diagnostics and treatment.
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Affiliation(s)
- Charly Gaul
- Kopfschmerzzentrum Frankfurt, Dalbergstr. 2a, 65929, Frankfurt, Deutschland.
| | - Wanlin Fan
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Ludwig M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Tim Jürgens
- Klinik und Poliklinik für Neurologie, Kopfschmerzzentrum Nord-Ost, Universitätsmedizin Rostock, Rostock, Deutschland
- Neurologische Klinik, KMG Klinikum Güstrow, Güstrow, Deutschland
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7
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Takkar A, Kumar KVA, Katoch D, Singh P, Minz R, Anand S, Kathirvel S, Ravishankar K, Lal V, Caplan LR. Serum Calcitonin Gene-Related Peptide Is Elevated in Patients With Migraine and Ophthalmoplegia. J Neuroophthalmol 2023; 43:399-405. [PMID: 36255114 DOI: 10.1097/wno.0000000000001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is ongoing debate about whether the oculomotor (III), trochlear (IV), or abducens (VI) nerve paresis in patients with migraine is directly attributable to migraine (ophthalmoplegic migraine [OM]) or is due to an inflammatory neuropathy (recurrent painful ophthalmoplegic neuropathy [RPON]). As migraine is associated with elevated serum calcitonin gene-related peptide (CGRP) levels, we studied serum CGRP levels among patients with OM/RPON to determine whether they are elevated during and between attacks. This is the first study assessing CGRP levels in the serum of patients with OM/RPON. METHODS The aim of this case-control study was to assess serum CGRP levels in patients with ophthalmoplegia and a headache consistent with migraine according to ICHD-3 criteria. Serum CGRP levels were measured during the ictal and interictal phases in 15 patients with OM/RPON and compared with age-matched and sex-matched controls without migraine (12 patients). RESULTS The median serum CGRP levels were significantly elevated ( P = 0.021) during the ictal phase (37.2 [36.4, 43.6] ng/L) compared with controls (32.5 [30.1, 37.3] ng/L). Serum CGRP levels during the attack correlated with the total duration of ophthalmoplegia. A CGRP level of 35.5 ng/L in the ictal phase of the attack had a sensitivity of 86.7% and specificity of 75.0% in diagnosing a patient with OM/RPON. CONCLUSIONS Elevated serum CGRP levels during the ictal phase of OM/RPON favor migraine as the underlying cause of episodic headache with ophthalmoplegia.
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Affiliation(s)
- Aastha Takkar
- Departments of Neurology (AT, VL), Internal Medicine (KVAK), Ophthalmology (DK), Radiodiagnosis (PS), Immunopathology (RM, SA), and Community Medicine and School of Public Health (SK), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India ; The Headache and Migraine Clinics (KR), Jaslok and Lilavati Hospitals, Mumbai, India; and Beth Israel Deaconess Medical Center (LC) (LRC), and Department of Neurology (LC), Harvard University, Boston, Massachusetts
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8
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Alstadhaug KB, Bakkejord G, Bø HK. Could recurrent painful ophthalmoplegic neuropathy be caused by a neurovascular conflict?: A case report. CEPHALALGIA REPORTS 2023. [DOI: 10.1177/25158163231157628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Objective: Describe and discuss a typical case with recurrent painful ophthalmoplegic neuropathy (RPON), and demonstrate a likely extrinsic compression of the sixth cranial nerve by a vascular loop. Background: RPON is a rare, but well-known entity, characterized by attacks of ophthalmoplegia associated with ipsilateral headache. The etiology is unknown, but a neurovascular conflict (NVC) has been suggested as a cause. Method: A 62-year-old woman presented in the emergency department with a horizontal diplopia that developed a few hours after the onset of a left temporal headache. In the past she had presented to the clinic with the same problem several times. She had been thoroughly examined, but no cause had been found. The symptoms had resolved by themselves. In addition to a classic finding in RPON, gadolinium enhancement and thickening of a cranial nerve, the new MRI scanning detected an NVC. Herein we discuss the relevance of this finding. Conclusion: A neurovascular conflict causing inflammatory demyelination of a single cranial nerve and relapsing remitting painful ophthalmoplegic neuropathy is an alluring idea. However, it is hard to conceive theoretically, and more reported cases with compelling data are needed to give credibility to such an idea.
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Affiliation(s)
- Karl Bjørnar Alstadhaug
- Department of Neurology, Nordland Hospital Trust, Bodø, Norway
- Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Grete Bakkejord
- Department of Neurology, Nordland Hospital Trust, Bodø, Norway
| | - Hans Kristian Bø
- Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
- Department of Radiology, Nordland Hospital Trust, Bodø, Norway
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9
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Furia A, Liguori R, Donadio V. Recurrent Painful Ophthalmoplegic Neuropathy: A case report with atypical features and a review of the literature. Cephalalgia 2023; 43:3331024221133386. [PMID: 36694449 DOI: 10.1177/03331024221133386] [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: 01/26/2023]
Abstract
INTRODUCTION Recurrent Painful Ophthalmoplegic Neuropathy, previously known as Ophthalmoplegic Migraine, is a poorly characterized disorder mainly because there are few cases described. We report a new case of Recurrent Painful Ophthalmoplegic Neuropathy and a review of the literature to contribute to increasing the knowledge of the clinical features of this disorder. CASE REPORT AND REVIEW OF LITERATURE A 45-year-old woman presented with adult-onset recurrent attacks of abducens and oculomotor palsy associated with diplopia followed by headache. Most notably, pain always presented many days after oculomotor impairment, a feature never described in the literature. A diagnosis of possible Recurrent Painful Ophthalmoplegic Neuropathy was made after excluding other possible mimicking disorders. Symptoms usually resolved gradually with corticosteroid therapy, albeit without a clear-cut benefit.Clinical data collected from 1989 to 2022 showed that adult onset in Recurrent Painful Ophthalmoplegic Neuropathy is not uncommon. While III cranial nerve palsy is typical, VI and IV nerve palsy have also been described. PATHOPHYSIOLOGY AND DIAGNOSIS Several hypotheses have been proposed, including nerve compression, ischemia or inflammation/demyelination, but none has been completely accepted.Diagnosis remains of exclusion; magnetic resonance imaging and blood exams are key in differential diagnosis. CONCLUSIONS Our case gives us the possibility to expand the clinical features of Recurrent Painful Ophthalmoplegic Neuropathy, also contributing to updating the pathophysiological hypotheses.
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Affiliation(s)
- Alessandro Furia
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Italia
| | - Vincenzo Donadio
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
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10
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Mahović D, Bračić M, Jovanović I, Gabrić ID. Recurrent Painful Ophthalmoplegic Neuropathy Mistaken for Oculomotor Schwannoma: A Case Report. JOURNAL OF PEDIATRIC NEUROLOGY 2022. [DOI: 10.1055/s-0042-1760197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AbstractRecurrent painful ophthalmoplegic neuropathy (RPON) is a headache disorder classified as a cranial neuropathy. It is characterized by episodes of unilateral headache followed by ipsilateral ophthalmoplegia due to ocular cranial nerve palsy. Symptoms usually subside spontaneously within weeks to months. RPON commonly occurs in childhood, though it is overlooked at times as a possible differential diagnosis. The pathophysiology of RPON is not entirely clear. Typical magnetic resonance imaging (MRI) findings in children include nerve thickening and gadolinium enhancement. However, these findings are not specific to this condition. Nerve thickening in RPON can resemble schwannomas, thereby causing a diagnostic dilemma. Here, we present a 13-year-old boy with a history of unilateral headaches associated with ipsilateral ptosis and diplopia. The first MRI indicated thickening and gadolinium enhancement of the right oculomotor nerve, which was interpreted as a schwannoma. However, his symptoms resolved after a few weeks and the follow-up MRI showed resolution of nerve changes. This clinical presentation was consistent with RPON. This case demonstrates the need for a careful follow-up of RPON patients.
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Affiliation(s)
- Darija Mahović
- Department of Neurology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Matea Bračić
- Department of School and Adolescent Medicine, Andrija Štampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Ivan Jovanović
- Department of Neuroradiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ivo Darko Gabrić
- Department of Cardiology, University Hospital Center “Sestre Milosrdnice,” School of Medicine, Croatian Catholic University, Zagreb, Croatia
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11
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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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12
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Dhoot R, Sengupta S. Recurrent painful ophthalmoplegic neuropathy with headache and oculomotor palsy 18 years apart. Headache 2022; 62:1434-1436. [PMID: 36373830 DOI: 10.1111/head.14422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Roshni Dhoot
- Department of Neurology, Duke University, Durham, North Carolina, USA
| | - Sweta Sengupta
- Department of Neurology, Duke University, Durham, North Carolina, USA
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13
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Xu M, Jiang J, He Y, Gu WY, Jin B. Early-onset ophthalmoplegia, cervical dyskinesia, and lower extremity weakness due to partial deletion of chromosome 16: A case report. World J Clin Cases 2022; 10:9332-9339. [PMID: 36159412 PMCID: PMC9477676 DOI: 10.12998/wjcc.v10.i26.9332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/08/2022] [Accepted: 07/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We explored the genotype-phenotype correlation of the novel deletion 16p13.2p12.3 in an 8-year-old child with progressive total ophthalmoplegia, cervical dyskinesia, and lower limb weakness by comparing the patient’s clinical features with previously reported data on adjacent copy number variation (CNV) regions.
CASE SUMMARY Specifically, we first performed whole-exome sequencing, CNV-sequencing, and mitochondrial genome sequencing on the patient and his parents, then applied “MitoExome” (the entire mitochondrial genome and exons of nuclear genes encoding the mitochondrial proteome) analysis to screen for genetic mitochondrial diseases. We identified a de novo 7.23 Mb deletion, covering 16p13.2p12.3, by both whole-exome sequencing and CNV sequencing. We also detected 16p13.11 in the deleted region, which is the recurrent distinct region associated with neurodevelopmental disorder. However, the patient only displayed features of progressive total ophthalmoplegia, cervical dyskinesia, and weakness in his lower limbs without neurodevelopmental disorder. The “MitoExome” sequencing was negative. Brain magnetic resonance imaging revealed non-specific sporadic changes in the occipital parietal lobe and basal ganglia.
CONCLUSION Taken together, these results indicated that 16p13.2p12.3 deletion causes a syndrome with the phenotype of early-onset total ophthalmoplegia. The “MitoExome” analysis is powerful for the differential diagnosis of mitochondrial diseases. We report a novel copy number variant in this case, but further confirmation is required.
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Affiliation(s)
- Min Xu
- Department of Neurology, Children’s Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
| | - Jiao Jiang
- Department of Neurology, Children’s Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
| | - Yan He
- Department of Neurology, Children’s Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
| | - Wei-Yue Gu
- Chigene (Beijing), Translational Medical Research Center Co. Ltd, Beijing 101111, China
| | - Bo Jin
- Department of Neurology, Children’s Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
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14
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Irwin SL, Greene KA, Pavitt SJ, Ross AC. Headache in the Pediatric Population: Focus on Migraine. Semin Neurol 2022; 42:479-488. [DOI: 10.1055/s-0042-1757927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPediatric headache is a common condition with significant impact on quality of life and ability to function in academic, social, and extracurricular activities. Most pediatric patients seen in primary care and neurology clinics with headache have primary headache disorders. Diagnosis is largely based on clinical history. Imaging is rarely needed in the absence of red flag features. Careful diagnosis is important to guide appropriate treatment. Treatment focuses on a biopsychosocial model integrating lifestyle, pharmacologic and nonpharmacologic treatment modalities. As few therapies are approved in the pediatric population, treatments are often used off-label based on evidence extrapolated from adult studies. Outcomes vary over time but are generally favorable when headache disorders are diagnosed promptly and managed in a multidisciplinary setting.
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Affiliation(s)
- Samantha L. Irwin
- Department of Neurology, University of California, San Francisco (UCSF), California
| | - Kaitlin A. Greene
- Division of Pediatric Neurology, Department of Pediatrics, Oregon Health and Science University (OHSU), Portland, Oregon
| | - Sara J. Pavitt
- Department of Neurology, University of Texas, Austin, Texas
| | - Alexandra C. Ross
- Department of Pediatrics, University of California, San Francisco (UCSF), California
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15
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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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16
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Ansari SM, Dua SG, Mafraji M. Recurrent Painful Ophthalmoplegic Neuropathy in an Adult Patient: A Case Report With Literature Review. Cureus 2022; 14:e25297. [PMID: 35755526 PMCID: PMC9223826 DOI: 10.7759/cureus.25297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/14/2022] Open
Abstract
Recurrent painful ophthalmoplegic neuropathy (RPON), previously known as ophthalmoplegic migraine, is a rare disease that predominantly affects children. Recurrent episodes of ocular cranial nerve paresis with ipsilateral headache characterize this disorder. Diagnosis is mainly clinical with imaging being used as an adjunct. The pathophysiology of the disease is unknown. We present here a case of RPON in a 50-year-old female presenting with multiple episodes of headache and diplopia with associated transient thickening and enhancement of the ipsilateral oculomotor nerve on magnetic resonance imaging (MRI).
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17
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Sakamoto N, Hongo Y, Takazaki H, Kaida K, Ikewaki K, Suzuki K. [A case of recurrent headache and ophthalmoplegia with a contrast-enhanced lesion of the oculomotor nerve in the cavernous region: an atypical phenotype of recurrent painful ophthalmoplegic neuropathy]. Rinsho Shinkeigaku 2022; 62:281-285. [PMID: 35354725 DOI: 10.5692/clinicalneurol.cn-001691] [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: 11/05/2022]
Abstract
The patient was a 14-year-old boy with two previous episodes of self-remitting right ophthalmoplegia with right temporal pain at ages 9 and 12. In 2019, he developed right eyelid ptosis and diplopia 2 days after a pulsating right-sided temporoparietal headache. Recurrent headaches with ophthalmoplegia responded to high-dose steroid therapy, and the clinical features resembled recurrent painful ophthalmoplegic neuropathy (RPON). RPON generally presents with MRI findings of hypertrophy and inflammation at the root of the oculomotor nerve, a vulnerable site of the blood-brain barrier. However, the imaging features in this case were different from those in typical cases of RPON, and oculomotor nerve inflammation was found in the cavernous sinus. The order of onset of headache and oculomotor nerve palsy differed in each recurrence, suggesting that both autoimmune and vascular mechanisms may have been involved in the onset of the disease in our case.
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Affiliation(s)
- Naohiro Sakamoto
- Department of Neurology, Anti-aging and Vascular medicine, Division of Internal Medicine, National Defense Medical College
| | - Yu Hongo
- Department of Neurology, Anti-aging and Vascular medicine, Division of Internal Medicine, National Defense Medical College
| | - Hiroshi Takazaki
- Department of Neurology, Anti-aging and Vascular medicine, Division of Internal Medicine, National Defense Medical College
| | - Kenichi Kaida
- Department of Neurology, Anti-aging and Vascular medicine, Division of Internal Medicine, National Defense Medical College.,Department of Neurology, Saitama Medical Center, Saitama Medical University
| | - Katsunori Ikewaki
- Department of Neurology, Anti-aging and Vascular medicine, Division of Internal Medicine, National Defense Medical College
| | - Kazushi Suzuki
- Department of Neurology, Anti-aging and Vascular medicine, Division of Internal Medicine, National Defense Medical College
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18
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Bui LT, Mainali G, Naik S, Cockroft K, Thamburaj K. Role of Neurovascular Compression of Oculomotor Nerve in Ophthalmoplegic Migraine. Cureus 2022; 14:e22919. [PMID: 35399433 PMCID: PMC8985736 DOI: 10.7759/cureus.22919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/22/2022] Open
Abstract
Ophthalmoplegic migraine is considered to occur more commonly in children than in adults. It commonly affects the oculomotor nerve among the cranial nerves. Demyelination of the nerve is proposed as the main mechanism for the etiology of ophthalmoplegic migraine, though it is not fully understood. Neurovascular compression as a cause of ophthalmoplegic migraine has not been well demonstrated in children. In this report, we present a case of a 13-year-old male with recurrent episodes of left ophthalmoplegic migraine. Oculomotor nerve enhancement with swelling was evident on MRI at the exit zone. Magnetic resonance angiography (MRA) revealed a sharp loop of the left posterior cerebral artery compressing the nerve. The case highlighted the unusual etiology of neurovascular compression resulting in ophthalmoplegic migraine in a pediatric patient. A supplemental case of ophthalmoplegic migraine in a seven-year-old male is also shown to highlight the role of neurovascular compression and the importance of using MR angiography to evaluate cases presenting clinically with ophthalmoplegic migraine.
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19
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Jones DL, Ma J, Yang M, Duong A, Richani K. Pediatric Ptosis: A Review of Less Common Causes. Int Ophthalmol Clin 2022; 62:177-202. [PMID: 34965234 DOI: 10.1097/iio.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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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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21
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Husain ZI, AlSayegh R, Humaidan H. A case report of isolated abducens nerve palsy: idiopathic or ophthalmoplegic neuropathy? THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00417-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Abducens nerve is the most common nerve affected among other cranial nerves in terms of isolated ocular palsy. Despite its prevalence and progression made in neuroimaging, incidence of idiopathic cases continues to rise.
Case presentation
We report a young adult male with no previous illnesses, who presented with sudden onset of binocular diplopia and headache and was later diagnosed with an isolated ipsilateral abducens nerve palsy secondary to an unknown cause and treated with steroids. The palsy and diplopia had resolved in 2-month time but the patient still continued to suffer from a migraine, such as headache.
Conclusion
Although, we labelled the patient as idiopathic initially, another plausible cause for this kind of presentation could be recurrent painful ophthalmoplegic neuropathy (RPON) owing to the nature of the presentation. Cases labelled as idiopathic could be attributed to a defined pathogenesis with detailed history and follow-up. Follow-up is vital for all patients, especially those labelled as idiopathic as recurrence of the illness have the chance of changing the diagnosis if supported by the detailed history and physical examination findings.
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22
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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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23
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Alam A, Iqubal MS, Kumar B, Azad ZR. A case of adult-onset ophthalmoplegic migraine. Neurol India 2021; 69:1805-1807. [PMID: 34979694 DOI: 10.4103/0028-3886.333444] [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: 11/04/2022]
Abstract
Ophthalmoplegic migraine (OM) also called recurrent painful ophthalmoplegic neuropathy (RPON) is not a so common disorder. It is characterized by childhood onset, ophthalmoplegia and migraine type of headache. The most common involved nerve is third cranial nerve. Involvement of fourth and sixth cranial nerve is unlikely. Adult cases are not so common. This is a case report of a man who presented with left-sided severe headache and diplopia of left eye. He had left oculomotor nerve palsy. The patient responded to treatment and recovered.
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Affiliation(s)
- Anwar Alam
- Department of Neurology, Nalanda Medical College and Hospital, Patna, Bihar, India
| | - Md Shahid Iqubal
- Department of Medicine, Nalanda Medical College and Hospital, Patna, Bihar, India
| | - Baidyanath Kumar
- Department of Neurology, Nalanda Medical College and Hospital, Patna, Bihar, India
| | - Zeyaur R Azad
- Department of Neurology, Nalanda Medical College and Hospital, Patna, Bihar, India
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24
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Neuro-image: recurrent painful ophthalmoplegic neuropathy. Acta Neurol Belg 2021; 121:1331-1333. [PMID: 34357545 DOI: 10.1007/s13760-021-01762-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/19/2021] [Indexed: 11/27/2022]
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25
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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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26
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Mollan SP, Virdee JS, Bilton EJ, Thaller M, Krishan A, Sinclair AJ. Headache for ophthalmologists: current advances in headache understanding and management. Eye (Lond) 2021; 35:1574-1586. [PMID: 33580185 PMCID: PMC8169696 DOI: 10.1038/s41433-021-01421-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/07/2020] [Accepted: 01/18/2021] [Indexed: 12/26/2022] Open
Abstract
Patients with headache and head pain are often referred to ophthalmologists. These symptoms can either be associated with underlying ophthalmic conditions, or more often are headache disorders unrelated to the eyes. Understanding the phenotype of the headache is critical for advice, safe discharge or onward referral. This review will provide an update on the criteria for common headache disorders that are often seen by ophthalmology and embrace disorders associated with ophthalmic diseases. It will also describe the changing management of migraine and outline recent therapies that are currently available.
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Affiliation(s)
- Susan P Mollan
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK
| | - Jasvir S Virdee
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK
| | - Edward J Bilton
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK
| | - Mark Thaller
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK
| | - Anita Krishan
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - Alexandra J Sinclair
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK.
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, B15 2TT, UK.
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27
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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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28
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Ghavi L, Pal J, Chang S, Chakraborty A. Recurrent Unilateral Ophthalmoplegia in a 5-year-old. Pediatr Rev 2021; 42:S52-S54. [PMID: 33386362 DOI: 10.1542/pir.2019-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Lila Ghavi
- Pediatric Emergency Medicine Associates, Children's Healthcare of Atlanta, Atlanta, GA
| | - Jayati Pal
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Simone Chang
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, University of Louisville, Louisville, KY
| | - Abhishek Chakraborty
- Department of Pediatric Hematology-Oncology and Stem Cell Transplantation, University of Louisville, Louisville, KY .,Division of Cardiology, LeBonheur Children's Hospital, University of Tennessee, Memphis, TN
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29
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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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30
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Pedro MKF, De Souza TFS. "Stat Rosa Pristina Nomine, Nomina Nuda Tenemus": The Many Syndromes, Diseases, and Anatomic Structures Bearing Jean-Martin Charcot's Name. Eur Neurol 2020; 83:550-553. [PMID: 33017831 DOI: 10.1159/000511028] [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: 04/02/2020] [Accepted: 08/15/2020] [Indexed: 11/19/2022]
Abstract
The sheer magnitude of Jean-Martin Charcot's contributions to neurology, pathology, psychiatry, and internal medicine has allowed for the common usage of eponyms bearing the master's name in recognition of his work. However, these are so numerous that confusion has naturally arisen concerning the exact nature of each eponym, allowing for different specialists to refer to completely different ailments or symptoms, while using the very same expression. Previous compilations of his eponyms were often incomplete. Therefore, the authors aimed to bring some clarification into the nature and origin of each known eponym with Charcot's name.
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31
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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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32
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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 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] [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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33
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Yan Y, Zhang B, Lou Z, Liu K, Lou M, Ding M, Xu Y. A Case of Recurrent Painful Ophthalmoplegic Neuropathy. Front Neurol 2020; 11:440. [PMID: 32582004 PMCID: PMC7287175 DOI: 10.3389/fneur.2020.00440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 04/24/2020] [Indexed: 01/03/2023] Open
Abstract
Ophthalmoplegic migraine (OM) is characterized by recurrent episodes of headache with unilateral ophthalmoplegia due to paresis of cranial nerve III, IV, or VI. The recent revision to the International Headache Classification has reclassified it as recurrent painful ophthalmoplegic neuropathy (RPON). However, it is of note that the presentation of oculomotor nerve tumors may mimic RPON. Here, we report the case of a patient presenting with recurrent migraine and oculomotor palsy with several specific magnetic resonance imaging (MRI) findings. The patient was initially diagnosed with migraine 15 years ago, but since 10 years ago, his symptoms had evolved to include repeated oculomotor paralyzes. Before this attack, the patient did eventually recover completely each time after the initial episode. MRI performed during this attack revealed a nodular enhancing lesion described as schwannoma of the left oculomotor nerve, and on diffusion-weighted imaging (DWI), the nerve was isointense to the midbrain. The nodular enhancement became weaker, and the nerve's signal on DWI disappeared 3 months later as the patient's symptoms resolved mostly. This is the first case of RPON demonstrating an obvious change in signal of the affected nerve on DWI during the attack and remission.
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Affiliation(s)
- Yaping Yan
- Department of Neurology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Bo Zhang
- Department of Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhuocong Lou
- Department of Neurology, Affiliated Hospital of Shaoxing University, Shaoxing, China
| | - Kaiming Liu
- Department of Neurology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ming Lou
- Department of Neurology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Meiping Ding
- Department of Neurology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yongfeng Xu
- Department of Neurology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Neuro-Ophthalmic Symptoms of Primary Headache Disorders: Why the Patient With Headache May Present to Neuro-Ophthalmology. J Neuroophthalmol 2020; 39:200-207. [PMID: 31022065 DOI: 10.1097/wno.0000000000000790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Primary headache disorders can cause many ophthalmic symptoms that lead many patients to present for neuro-ophthalmic evaluation. Neuro-ophthalmologists frequently encounter these patients in clinical practice. EVIDENCE ACQUISITION A literature review was completed in PubMed using the following terms paired with "migraine" and "headache:" dry eye, eye pain, monocular diplopia, binocular diplopia, photophobia, visual field defect, tunnel vision, floaters, amaurosis fugax, transient visual obscuration, autonomic symptoms, anisocoria, visual snow, Alice in Wonderland syndrome, and palinopsia. RESULTS Patients with migraine experience a wide range of visual disturbances including aura and more complex perceptual abnormalities such as Alice in Wonderland syndrome and visual snow. Visual disturbances may consist of positive and/or negative phenomena and may be binocular or monocular. Migraine and other primary headache disorders can be associated with photophobia, eye pain, dry eye, autonomic features, and anisocoria. CONCLUSIONS Patients with primary headache disorders may experience a wide range of visual and ophthalmic symptoms. An understanding of the typical features of these disorders allows providers to help patients find appropriate treatment without unnecessary testing and to recognize when atypical presentations require additional evaluation.
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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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Abstract
Migraine is a common headache disorder characterized by often-severe headaches that may be preceded or accompanied by a variety of visual symptoms. Although a typical migraine aura is not difficult to diagnose, patients with migraine may report several other visual symptoms, such as prolonged or otherwise atypical auras, "visual blurring", "retinal migraine", "ophthalmoplegic migraine", photophobia, palinopsia, and "visual snow". Here, we provide a short overview of these symptoms and what is known about the relationship with migraine pathophysiology. For some symptoms, the association with migraine is still debated; for other symptoms, recent studies indicate that migraine mechanisms play a role.
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Affiliation(s)
- Robin M. van Dongen
- Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Joost Haan
- Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Neurology, Alrijne Ziekenhuis, Simon Smitweg 1, 2353 GA, Leiderdorp, The Netherlands
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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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Repka MX. Don't Miss This! Red Flags in the Pediatric Eye Examination: Ophthalmoplegia in Childhood. J Binocul Vis Ocul Motil 2019; 69:93-97. [PMID: 31329057 DOI: 10.1080/2576117x.2019.1590141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/16/2019] [Accepted: 02/22/2019] [Indexed: 06/10/2023]
Abstract
Paralytic strabismus in children is rare, occurring in about 0.1% of children. This rate is far less common than the 3% rate usually noted for comitant strabismus. The relative rates of ocular motor pareses were fourth nerve palsies in 36%, sixth in 33%, third in 22%, with multiple ocular motor nerve palsies in 9%. In a single population series from Minnesota, few cases were associated with neoplasm. However, institutional case series reports a high rate of neoplasm for acquired third nerve and sixth nerve palsies after excluding trauma and congenital causes. Tumor is rare in children with fourth cranial nerve palsies, usually associated with other neurologic disease. Rare causes of external ophthalmoplegia, to be considered when the motility pattern is variable or not fitting an ocular motor nerve pattern, include myasthenia gravis and congenital fibrosis of the extraocular muscles. Myasthenia most often presents as ptosis with exotropia. Rarer still is involvement of the extraocular muscles in childhood thyroid disease.
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Affiliation(s)
- Michael X Repka
- a Ophthalmology, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
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Sharifi A, Kayfan S, Clarke RL, Mehta A, Pfeifer CM. Recurrent painful ophthalmoplegic neuropathy: MRI findings in 2 patients. Radiol Case Rep 2019; 14:1039-1042. [PMID: 31236187 PMCID: PMC6582055 DOI: 10.1016/j.radcr.2019.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022] Open
Abstract
Recurrent painful ophthalmoplegic neuropathy is a form of cranial neuralgia and rare source of pediatric headache. We present 2 children who presented with headaches accompanied by visual symptoms including eye pain, blurry vision, and diplopia. MRI in both patients demonstrated enhancement of the cisternal segment of the oculomotor nerve in the affected side, correlating with the observed symptoms.
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Affiliation(s)
- Arghavan Sharifi
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Samar Kayfan
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Rebekah L Clarke
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Akshita Mehta
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Cory M Pfeifer
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
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Treatment of Recurrent Painful Ophthalmoplegic Neuropathy: A Case Where Pregabalin Was Successfully Employed. Case Rep Neurol Med 2019; 2019:9185603. [PMID: 30881712 PMCID: PMC6383397 DOI: 10.1155/2019/9185603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/27/2019] [Indexed: 01/03/2023] Open
Abstract
Recurrent painful ophthalmoplegic neuropathy, previously known as ophthalmoplegic migraine, is a rare condition that affects children and young adults. Its cause and classification are still controversial and, consequently, there are no published treatment guidelines or consensus. Glucocorticoids seem to be beneficial for some patients, but there is no established treatment when failure of this therapy occurs. The aim of this study was to report a case where pregabalin was successfully used after failure of glucocorticoid therapy in a patient with recurrent painful ophthalmoplegic neuropathy.
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41
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Moloney P, Hughes NM, Killeen RP, O' Riordan S. A Case of Recurrent Painful Ophthalmoplegic Neuropathy with Associated Oculomotor Nerve Tumour. Neuroophthalmology 2018; 44:28-33. [PMID: 32076446 DOI: 10.1080/01658107.2018.1534870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/27/2018] [Accepted: 10/08/2018] [Indexed: 01/03/2023] Open
Abstract
Recurrent painful ophthalmoplegic neuropathy (RPON) replaced the term 'ophthalmoplegic migraine' as the condition behaves more like an inflammatory cranial neuropathy than a primary headache disorder. RPON may be associated with cranial nerve thickening on MR imaging and persistent oculomotor paresis. Oculomotor tumours have rarely been described in cases of relapsing painful ophthalmoplegia with and without persistent paresis. Here, we present a case of relapsing painful left ophthalmoplegia that gradually became persistent. MR imaging after 14 years of symptoms revealed an enhancing tumour of the left oculomotor nerve. It is unclear whether the tumour was the cause of the attacks or whether repeated cycles could lead to tumour development. MR imaging is indicated in patients with RPON who develop persistent deficits to screen for associated oculomotor tumour.
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Affiliation(s)
- Patrick Moloney
- Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland
| | - Nicola M Hughes
- Department of Neuroradiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Ronan P Killeen
- Department of Neuroradiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Sean O' Riordan
- Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland
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Abstract
PURPOSE OF REVIEW Neuralgias are characterized by pain in the distribution of a cranial or cervical nerve. Typically, they are brief, paroxysmal, painful attacks, although continuous neuropathic pain may occur. The most commonly encountered conditions are trigeminal, postherpetic, and occipital neuralgia. Less common neuralgias include glossopharyngeal, superior laryngeal, auriculotemporal, and nervus intermedius neuralgia, among others. The approach to diagnosis and treatment of this group of disorders is reviewed. RECENT FINDINGS Recent guidelines of medication administration, the use of botulinum toxin, and more targeted procedures have improved treatment of neuralgias. Patients who present with neuralgias should have imaging studies to investigate for structural abnormalities unless the etiology is apparent. Management of both common and rare neuralgias can be challenging and is best guided by the most recent available evidence.
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Affiliation(s)
- Danielle Wilhour
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Stephanie J Nahas
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Relapsing Painful Ophthalmoplegic Neuropathy: No longer a “Migraine,” but Still a Headache. Curr Pain Headache Rep 2018; 22:50. [DOI: 10.1007/s11916-018-0705-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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44
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Hurd A, Sabo T. Episodic Ophthalmoplegia and Headache With Cranial Nerve III Enhancement on MRI. Headache 2018; 58:1685-1686. [PMID: 29781167 DOI: 10.1111/head.13329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew Hurd
- Children's Health Children's Medical Center, Dallas, TX, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tonia Sabo
- Children's Health Children's Medical Center, Dallas, TX, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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45
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Okura Y, Wakayama A, Yoshizawa C, Kobayashi I, Takahashi Y. Recurrent painful ophthalmoplegic neuropathy in a 12-year-old boy. Pediatr Int 2017; 59:1208-1210. [PMID: 29359372 DOI: 10.1111/ped.13393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/04/2017] [Accepted: 08/07/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Yuka Okura
- Department of Pediatrics, KKR Sapporo Medical Center, Sapporo, Japan
| | - Akiko Wakayama
- Department of Ophthalmology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Chikako Yoshizawa
- Department of Ophthalmology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Ichiro Kobayashi
- Department of Pediatrics, KKR Sapporo Medical Center, Sapporo, Japan
| | - Yutaka Takahashi
- Department of Pediatrics, KKR Sapporo Medical Center, Sapporo, Japan
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Kobayashi Y, Kondo Y, Uchibori K, Tsuyuzaki J. Recurrent Painful Ophthalmoplegic Neuropathy with Residual Mydriasis in an Adult: Should it Be Classified as Ophthalmoplegic Migraine? Intern Med 2017; 56:2769-2772. [PMID: 28924127 PMCID: PMC5675941 DOI: 10.2169/internalmedicine.8842-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Recurrent painful ophthalmoplegic neuropathy (RPON) is a rare condition that manifests as headache and ophthalmoplegia. It typically occurs in children. Although migraine or neuropathy have been suggested as etiologies, the precise etiology remains unclear. In the International Classification of Headache Disorders 3rd edition-beta version (ICHD3β) (code 13.9), RPON was categorized into painful cranial neuropathies and other facial pains. We encountered a 48-year-old woman who had diplopia and right ptosis. The administration of prednisolone led to the immediate improvement of her oculomotor palsy, but residual mydriasis remained. Based on this case, the pathophysiology of RPON may involve temporary nerve inflammation with migraine. Repeated and severe migraine attacks may cause irreversible nerve damage. Thus, medication for migraine prophylaxis might be needed to prevent RPON.
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47
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Huang C, Amasanti M, Lovell B, Young T. Recurrent painful ophthalmoplegic neuropathy. Pract Neurol 2017; 17:318-320. [PMID: 28473604 DOI: 10.1136/practneurol-2016-001530] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 01/03/2023]
Abstract
Recurrent painful ophthalmologic neuropathy (RPON), previously termed ophthalmoplegic migraine, is characterised by repeated attacks of one or more ocular cranial nerve palsies with ipsilateral headache. Its cause remains unclear; it is currently thought to be neuropathic in origin, but there is debate in the literature. In documented cases, a third cranial nerve palsy is by far the most common. Here we present a case of RPON involveing the fourth and sixth cranial nervesonly. Thorough investigation, including MR scan of brain and lumbar puncture, found no alternative explanation. This case adds to the debate over whether the cause of RPON is truly neuropathic or migrainous.
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Affiliation(s)
- Cleo Huang
- Acute Medicine Unit, Whittington Hospital NHS Trust, London, UK
| | - Maria Amasanti
- Acute Medicine Unit, Whittington Hospital NHS Trust, London, UK
| | - Ben Lovell
- Acute Medicine Unit, Whittington Hospital NHS Trust, London, UK
| | - Tim Young
- Acute Medicine Unit, Whittington Hospital NHS Trust, London, UK
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Abstract
Blepharoptosis or drooping of upper eye lid is a common, but non-specific sign of neurological diseases which sometimes could herald a life-threatening disorder. First, the diagnosis of ptosis should be established by considering four clinical measurements: palpebral fissure height, marginal reflex distance, upper eyelid crease, and levator function test. The diagnostic categories of ptosis are scheduled as pseudo-ptosis, congenital, and acquired ptosis. Acquired causes include mechanical, myogenic, neuromuscular, neurogenic, and cerebral. Each category with diseases presenting with ptosis was described in detail. Considering some features, such as involvement of other cranial nerves, extraocular muscle, pupil size and reactivity, and unilateral or bilateral presentation of ptosis, could help to narrow the differential diagnosis.
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Abstract
Ophthalmoplegic migraine (OM)/recurrent painful ophthalmoplegic neuropathy (RPON) is a rare disease consisting of recurrent unilateral headache accompanied or followed by ipsilateral ophthalmoplegia. Because MRI findings suggest neuropathy and the relationship to typical migraine remains unclear, the disease has been renamed from "ophthalmoplegic migraine" to "recurrent painful oculomotor neuropathy" in the third edition of the International Classification of Headache Disorders (ICHD). However, it remains a fact that most cases of OM/RPON described in the literature have a history of migraine and that the headache during OM/RPON often has migrainous features. A more detailed clinical description of the headache during OM/RPON and additional results from imaging and possibly histology will be needed to better understand the pathophysiology of the disease and its relationship to typical migraine.
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50
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Gofshteyn JS, Stephenson DJ. Diagnosis and Management of Childhood Headache. Curr Probl Pediatr Adolesc Health Care 2016; 46:36-51. [PMID: 26750538 DOI: 10.1016/j.cppeds.2015.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
Headache is one of the most common chief complaints seen in the pediatrician's office. Oftentimes, identifying the etiology of headache and differentiating primary and secondary causes can present a diagnostic conundrum. Understanding the most common causes of primary and secondary headache is vital to making a correct diagnosis. Here we review the typical presentations of the most common primary headache disorders and the approach to evaluation of the pediatric patient presenting with headache. Diagnostic workup, including the key features to elicit on physical examination, when to order head imaging, and the use of other ancillary tests, is discussed. Current treatment modalities and their indications are reviewed. We will also describe some of the new, emerging therapies that may alter the way we manage headache in the pediatric population. Headache can, at times, be a frustrating symptom seen in the pediatrician's office, but here we hope to better elucidate the approach to evaluation, management, and treatment as well as provide some hope in regards to more effective upcoming therapies.
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Affiliation(s)
| | - Donna J Stephenson
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA.
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