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.

Key Clinical MessageWhilst hematospermia may indicate urological disease, it is a rare manifestation of severe systemic hypertension. We describe the case of a young man with hematospermia associated with a blood pressure of 228/135. Blood pressure treatment led to resolution of his hematospermia. Physicians must be aware of this potential association.

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