ABSTRACT
La Neuropatía oftalmopléjica dolorosa recurrente o migraña oftalmopléjica es una variante infrecuente de cefalea primaria. Se define como al menos dos episodios de cefalea unilateral que se acompaña de paresia ipsilateral de uno, dos o los tres nervios oculomotores. Se debe excluir una lesión orbitaria, paraselar o de la fosa posterior, y no debe ser mejor explicada por otro diagnóstico. Se describe el caso de un pre-escolar de 3 años, sin antecedentes a destacar, que presenta 3 episodios de oftalmoparesia caracterizada por ptosis palpebral y estrabismo divergente con descenso ocular del ojo izquierdo, de hasta 10 días de duración, precedido por irritabilidad, cefalea, vómitos y somnolencia posterior. Se realizó estudios de laboratorio, los cuales fueron normales. La resonancia magnética craneal mostró captación de contraste a nivel de la emergencia del III par craneano izquierdodurante uno de los episodios. Destacamos la importancia de considerar este cuadro como causa recurrente de parálisis óculo-motora. Consideramos importante el valor de la resonancia, no solo para descartar diagnósticos diferenciales, sino como herramienta de confirmación diagnóstica. Se reporta la reducción de los días de compromiso oculomotor tras la administración de corticoides.
Recurrent painful ophtalmoplegic neuropathy or ophthalmoplegic migrane is a rare type of primary headache. It is characterized as at least two episodes of unilateral headaches accompanied by ipsilateral paresis of one, two or the three ocular motor nerves. Orbital, parasellar and posterior fossa lessions must be excluded, and it is not better accounted by other diagnosis. We report clinical, imaging and laboratory tests of a three years old boy who developed three episodes of left eye ptosis with divergent strabismus and downgaze deviation of left eye, preceded by headache, irritability, vomiting and sleepiness. Ophtalmoparesis episodes lasted up to 10 days. Laboratory tests were normal. Magnetic resonance showed gadolinium enhancement of the third cranial nerve during one attack. We highlight the need to consider ophtalmoplegicmigrane in all cases of recurrent oculomotor palsy, and the importance of themagnetic resonance imaging, not just to rule out other possible etiologies, but also as a confirmative test. This case showed improvement of clinical signs after steroid therapy.
ABSTRACT
La migraña oftalmopléjica es una condición de la infancia caracterízada por crisis de severa cefalea hemicraneal seguida de parálisis ipsolateral de los nervios tercero, cuarto o sexto. Modernamente se explica mediante la teoría trigémino-vascular de la migraña. Aunque suele ser autolimitada puede dejar secuelas. Los autores comunican los casos de cuatro pacientes: tres niños con parálisis del tercer nervio craneal: una de ellas, desarrolló en el tiempo una regeneración aberrante secundaria, situación excepcional descrita en la literatura internacional en menos de diez pacientes. El último, un adulto con dos episodios de parálisis del sexto nervio craneal y una del tercer nervio. Se discuten sus manifestaciones clínicas y neurorradiológicas.
Ophthalmoplegic migraine in childhood is a painful migraine or headache complicated by an isolated III, IV or VI oculo-motor nerve palsy followed by total resolution without sequelae. The pathogenesis is unclear, however, more recently an hypothesis of trigeminovascular system activation have been proposed. The authors reported four patients with ophthalmoplegic migraine: three children with third cranial nerve palsy; one of them developed secondary aberrant regeneration of the third nerve. It is an exceptional case, because in the international literature less than ten patients had been reported. One case was an adult patient with recurrent nerve palsy (two episodes of sixth cranial nerve palsy and one event of third nerve palsy). Clinical and neuroradiological manifestations are discussed.
Subject(s)
Humans , Male , Adolescent , Female , Child , Young Adult , Blepharoptosis/etiology , /pathology , Magnetic Resonance Spectroscopy , Ophthalmoplegia, Chronic Progressive External/pathology , Facial Paralysis/physiopathology , Migraine Disorders/diagnosis , Paresis/etiology , Oculomotor Nerve Injuries/etiologyABSTRACT
Teniendo en cuenta los múltiples síntomas que suelen acompañar los episodios de migraña, son los síntomas visuales los que adquieren mayor porcentaje de presentación, los cuales pueden estar acompañados o no de cefalea. Estos síntomas pueden ubicarse dentro de un síndrome migrañoso específico como lo son la migraña con aura, aura típica sin cefalea, migraña retiniana y migraña oftalmoplégica. Se revisan y se presentan sus criterios diagnósticos y su manejo.
Visual phenomenon as part of the migraine syndrome.Literature review. Among the multiple symptoms, usually accompanying, the migraine episodes, there are the visual symptoms, which account for the highest incidence. These symptoms may or may no be accompanied by headache. These symptoms can be located into a specific migraine syndrome, such as migraine with aura, aura without migraine, retinal migraine and the ophthalmoplegic migraine. In this article we provide a topic review, as well as the diagnostic criteria and the management of this entity.
Subject(s)
Humans , Diagnosis , Diagnosis, Differential , Migraine Disorders , Migraine with Aura , Ophthalmoplegic MigraineABSTRACT
Ophthalmoplegic migraine is defined as recurrent unilateral headaches associated with extraocular muscle palsies. This disorder is more common in older children, but it may begin in infancy. Neuroimaging study should be performed to rule out conditions resulting in third nerve compression, such as intracranial aneurysm or mass lesions. Early treatment with corticosteroids could shorten the duration of the ophthalmoplegia and relieve the pain. We report a 8 year old boy who had severe headache with recurrent ipsilateral ophthalmoplegia that developed at the age of 2. The pediatrician should be aware that ophthalmoplegic migraine may occur in infancy and that early systemic steroid therapy is critical to prevent permanent sequelae.
Subject(s)
Child , Humans , Male , Adrenal Cortex Hormones , Headache , Intracranial Aneurysm , Magnetic Resonance Imaging , Neuroimaging , Ophthalmoplegia , Ophthalmoplegic Migraine , ParalysisABSTRACT
The typical manifestation of repeated migraine headache followed by ophthalmoplegia can be diagnosed as a ophthalmoplegic migraine. The diagnosis requires exclusion of other causes. MRI was useful in excluding other causes of ophthalmoplegia with headache and there is few abnormal findings on MRI in ophthalmoplegic migraine patients. A 55-year-old man with a familial and personal history of migraine was admitted due to left ptosis and diplopia followed by insidiously developed headache. The migraine headache and ophthalmoplegia were improved spontaneously within 3 days and within 4 weeks, respectively. MRI demonstrated gadolinium enhancement on the cisternal portion of left oculomotor nerve.