Last modified: 2014-04-03
Abstract
Ophthalmoplegic migraine(OM) is an uncommon type of headache, reclassified under cranial neuralgias in 2004. The International Classification of Headache Disorders defined OM as at least 2 attacks of ‘‘migraine-like’’ headache followed within 4 days by III, IV and/or VI cranial nerve(CN) palsy.
Purpose: To describe clinical and neuroimaging findings of two adolescents with OM and review the literature on OM in pediatrics.
Methods: Retrospective review of clinical records and all cases of OM published since 2004.
Results: Case 1: A 13-year-old female, with previous migraine, had two episodes of OM at 10 and 13 years of age. She developed ocular pain and complete left third CN palsy. Brain MRI showed third CN gadolinium enhancement. She was put on prednisone with complete recovery. Case 2: A 15-year-old female with a history of migraine had two attacks of hemicranial headache, ocular pain, eyelid ptosis, and diplopia with spontaneous full recovery. MRI showed left third CN gadolinium enhancement. Twenty-one cases have been reported. OM onset ranged from 9 months to 16 years and 56% had a history of headache. MRI showed third CN gadolinium enhancement in 69% of cases and in only one the fourth CN was involved. At follow-up imaging, 17% of cases had third CN thickening without enhancement.
Conclusion: OM is a rare condition in pediatrics. Brain MRI with third CN enhancement confirmed the diagnosis. The physiopathology remains unknown. A recurrent demyelinating cranial neuropathy has recently gained favor based on MRI findings but vascular/inflammatory mechanisms also has been considered.
Keywords
References
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