Recurrent Painful Ophthalmoplegic Neuropathy Affecting Right Oculomotor Nerve in 10-Year-Old Male. Case Report

  • Sharmila Segar Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
  • Chandni Duphare Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
  • Osemelu Aburime Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
Keywords: Ophthalmoplegic Migraine, Cranial Nerve Disease, Oculomotor Nerve

Abstract

Background: Recurrent painful ophthalmoplegic neuropathy (RPON), formerly known as ophthalmoplegic migraine (OM), is a poorly understood condition that presents with recurrent unilateral headaches and at least one ocular cranial nerve (CN) palsy, generally in childhood. There has been ongoing debate about whether the etiology of this disorder is neuropathic or related to migraines. The Case: We present a case about a 10-year-old male with his third presentation of RPON, repeatedly affecting his right oculomotor nerve. His treatment choices are discussed, along with associated outcomes. The patient was treated with topiramate with resolution of his symptoms occurred within one month. Conclusion: As the annual incidence of RPON is rare at fewer than 1 case per million people, clear documentation of observed cases with treatment failures and successes is key to building evidence for future management.

Author Biographies

Sharmila Segar, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.

Sharmila Segar is a fourth year medical student at the Medical College of Georgia, pursuing a career in ophthalmology.

Chandni Duphare, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.

Chandni Duphare is a fourth year medical student at the Medical College of Georgia, pursuing a career in ophthalmology.

Osemelu Aburime, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.

Dr. Aburime is starting his glaucoma fellowship at Ochsner Health System.

References

Forderreuther S, Ruscheweyh R. From ophthalmoplegic migraine to cranial neuropathy. Curr Pain Headache Rep. 2015 Jun;19(6):21.

Gelfand AA, Gelfand JM, Prabakhar P, Goadsby PJ. Ophthalmoplegic "migraine" or recurrent ophthalmoplegic cranial neuropathy: new cases and a systematic review. J Child Neurol. 2012 Jun;27(6):759-66.

Hansen SL, Borelli-Moller L, Strange P, Nielsen BM, Olesen J. Ophthalmoplegic migraine: diagnostic criteria, incidence of hospitalization and possible etiology. Acta Neurol Scand. 1990 Jan;81(1):54-60.

Headache Classification C, Olesen J, Bousser MG, Diener HC, Dodick D, First M, et al. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia. 2006 Jun;26(6):742-6.

Carlow TJ. Oculomotor ophthalmoplegic migraine: is it really migraine? J Neuroophthalmol. 2002 Sep;22(3):215-21.

Wilker SC, Rucker JC, Newman NJ, Biousse V, Tomsak RL. Pain in ischaemic ocular motor cranial nerve palsies. Br J Ophthalmol. 2009 Dec;93(12):1657-9.

Lal V. Ophthalmoplegic migraine: past, present and future. Neurol India. 2010 Jan-Feb;58(1):15-9.

Huang C, Amasanti M, Lovell B, Young T. Recurrent painful ophthalmoplegic neuropathy. Pract Neurol. 2017 Aug;17(4):318-20.

Manzouri B, Sainani A, Plant G, Lee J, Sloper J. The aetiology and management of long-lasting sixth nerve palsy in ophthalmoplegic migraine. Cephalalgia. 2007 Mar;27(3):275-8.

Akimoto J, Fukami S, Hashimoto R, Haraoka J. Neuromuscular hamartoma is a possible primary pathology of oculomotor ophthalmoplegic migraine. Cephalalgia. 2012 Jan;32(2):171-4.

Kawasaki A. Oculomotor nerve schwannoma associated with ophthalmoplegic migraine. Am J Ophthalmol. 1999 Nov;128(5):658-60.

Bisdorff AR, Wildanger G. Oculomotor nerve schwannoma mimicking ophthalmoplegic migraine. Cephalalgia. 2006 Sep;26(9):1157-9.

Shin RK, Mejico LJ, Kawasaki A, Purvin VA, Moster ML, Younge BR, et al. Transient ocular motor nerve palsies associated with presumed cranial nerve schwannomas. J Neuroophthalmol. 2015 Jun;35(2):139-43.

Mark AS, Casselman J, Brown D, Sanchez J, Kolsky M, Larsen TC, 3rd, et al. Ophthalmoplegic migraine: reversible enhancement and thickening of the cisternal segment of the oculomotor nerve on contrast-enhanced MR images. AJNR Am J Neuroradiol. 1998 Nov-Dec;19(10):1887-91.

Roy M, Ghosh J, Deb S, Pandit N. Childhood steroid-responsive ophthalmoplegic migraine. J Pediatr Neurosci. 2011 Jan;6(1):69-71.

Prats JM, Mateos B, Garaizar C. Resolution of MRI abnormalities of the oculomotor nerve in childhood ophthalmoplegic migraine. Cephalalgia. 1999 Sep;19(7):655-9.

Levin M, Ward TN. Ophthalmoplegic migraine. Curr Pain Headache Rep. 2004 Aug;8(4):306-9.

Sugiyama N, Hamano S, Tanaka M, Mochizuki M, Nara T. [MRI findings and effectiveness of cyproheptadine in two patients with ophthalmoplegic migraine]. No To Hattatsu. 2002 Nov;34(6):533-7. Japanese

Crevits L, Verschelde H, Casselman J. Ophthalmoplegic migraine: an unresolved problem. Cephalalgia. 2006 Oct;26(10):1255-9.

Published
2018-12-23
How to Cite
Segar, S., Duphare, C., & Aburime, O. (2018). Recurrent Painful Ophthalmoplegic Neuropathy Affecting Right Oculomotor Nerve in 10-Year-Old Male. Case Report. International Journal of Medical Students, 6(3), 114-117. Retrieved from http://www.ijms.info/index.php/IJMS/article/view/285
Section
Case Report