Ophthalmoplegic Migraine: Inflammatory Neuropathy with Secondary Migraine?

Abstract

Ophthalmoplegic migraine (OM) may be diagnosed after recurrent episodes of headache, followed by the paresis of one or more ocular cranial nerves (typically oculomotor 1 ). The diagnosis requires all other causes of focal intracranial neuropathy (i.e. vascular, inflammatory, tumor or infectious etiology), to be excluded. Contrast MR imaging typically reveals enhancement of the affected nerve at the site of its exit from the brainstem. 2 Ophthalmoplegic migraine is rare, with an annual incidence estimated at 0.7 per million. 3 However it does account for up to 7% of all isolated cases of childhood oculomotor nerve palsy. 4,5 ABSTRACT: Background: This critical review provides a summary of the clinical presentation, neuroimaging, treatment and prognosis in pediatric ophthalmoplegic migraine (OM). The features of OM are not in keeping with its classification as a migraine-variant. Method: We review 3 new and 37 reported pediatric OM cases. Results: Headache was an inconsistent feature, with 25% patients showing no evidence of pain at the initial OM episode. Patients demonstrated: 1) prolonged time for symptom resolution to occur (median time 3 weeks); 2) tendency for recurrent episodes to have more severe and persistent nerve involvement; 3) evidence of permanent neurological sequelae with recurrent episodes (30% of patients); 4) rapid improvement and shortened duration with corticosteroid therapy and; 5) transient, reversible MRI contrast enhancement of the affected cranial nerve (86% of patients). These features would not be expected in primary migraine headache. Conclusion: A detailed understanding of the natural history of OM is essential for the clinical. This review provides support that OM may result from cranial nerve inflammation with headache a secondary and later feature of this condition. RÉSUMÉ: La migraine ophtalmoplégique : s'agit-il d'une neuropathie inflammatoire avec migraine secondaire?Contexte : Cette revue présente un sommaire du tableau clinique, de la neuroimagerie, du traitement et du pronostic de la migraine ophtalmoplégique (MO) pédiatrique et une analyse critique ce ces données. Bien qu'on classifie la MO comme une forme variante de la migraine, ses manifestations ne cadrent pas avec cette classification. Méthode : Nous rapportons 3 nouvelles observations cliniques pédiatriques de MO et nous révisons 37 observations pédiatriques déjà rapportées. Résultats : La céphalée n'était pas toujours présente et 25% des patients n'avaient pas de douleur au moment du premier épisode de MO. À noter que : 1) les symptômes s'estompaient lentement (temps médian de 3 semaines) ; 2) au moment des rechutes, l'atteinte nerveuse avait tendance à être plus sévère et plus persistante ; 3) les patients ayant présenté plusieurs épisodes pouvaient avoir des signes de séquelles neurologiques permanentes (30% des patients) ; 4) la corticothérapie provoquait une amélioration rapide et des épisodes plus courts et 5) un rehaussement transitoire réversible du nerf crânien atteint était observé à l'IRM avec produit de co...

Simultaneous, Bilateral Ophthalmoplegia as the Presenting Sign of Paediatric Multiple Sclerosis: Case Report and Discussion of the Differential Diagnosis

“…4 Ophthalmoplegic migraine (OM) has been reported to present with bilateral involvement, presumably via peripheral microvascular ischaemia; 15 however, more recent evidence suggests that the underlying aetiology is inflammatory, as patients with OM demonstrate transient cranial nerve enhancement on MRI. 16 Rarely, giant cell arteritis (GCA; temporal arteritis) presents with bilateral ophthalmoplegia and is typically associated with systemic symptoms, including headache, mild fever, jaw claudication, weight loss, and proximal muscle weakness. 17,18 In patients over the age of 55 with ophthalmoplegia, erythrocyte sedimentation rate, C-reactive protein, and platelet count should be obtained.…”

Uncommon Headache Syndromes in the Pediatric Population

“…Of notice, preceding headache attacks often are prolonged (>1 week) and there is a latent period of up to 4 days from the onset of headache to the onset of ophthalmoplegia; tendency for recurrent episodes with more severe and persistent nerve involvement; evidence of permanent neurologic deficits with recurrent episodes (30% of patients); rapid improvement and shortened duration in response to corticosteroid therapy; and transient, reversible MRI contrast enhancement of the affected cranial nerve (86% of patients) [50].…”

A Clinical Study on the Case of Ophthalmoplegic Migraine Treated with Electroacupuncture

“…International Headache Society(HIS) 진단기준 에 따르면 안근마비성 편두통은 반복되는 편두 통성 두통과 동반된 하나 또는 그 이상의 뇌신 경마비가 존재하는 것으로 정의된다 2,12,20) . 안근 마비성 편두통의 발생률은 정확히 알려져 있지 않지만, Hansen은 매년 백만명 당 0.7명 정도로 추정하고 있으며 편두통과는 달리 남성에 더 호 발 한다고 보고하였다 2,14) .…”

“…안근 마비성 편두통의 발생률은 정확히 알려져 있지 않지만, Hansen은 매년 백만명 당 0.7명 정도로 추정하고 있으며 편두통과는 달리 남성에 더 호 발 한다고 보고하였다 2,14) . 안근마비성 편두통의 발생 기전은 정확하게 밝혀지지 않았으며 신경 학적 검사나 영상검사를 통해 다른 기질적인 질 환을 배제한 후에 진단할 수 있다 2,12,20) . .…”

“…. 안근 마비성 편두통은 모든 연령에서 발생할 수 있지 만 주로 10세 이전에 발생하고 성인이 된 이후 에 발병하는 일은 드물다 12,13,25) . 주로 3번 뇌신경 마비를 가장 많이 동반하게 되고 4번 뇌신경이 나 6번 뇌신경도 침범될 수 있다고 알려져 있다 2,12,14,15,25) .…”