A Case of Ophthalmoplegic Migraine: Reversible Ischemia Demontrated by Brain SPECT

ABSTRACT

Ophthalmoplegic migraine is a syndrome characterized by the typical history of migrainous headache followed by ophthalmoplegia in the absence of demonstrable intracranial lesion. Until now, investigations of regional cerebral blood flow (CBF) in patient,; with migraine have been performed during prodromal and/or headache phases by brain SPECT with Tc-99m HMPAO. However, no such paper has described patients with ophthalmoplegic migraine. We present a 14-year-old girl with 4 episodes of paroxysmal migrainous headache on the right fronto-orbital area without aura followed by ptosis and diplopia, which were always gradually resolved without aberrant regeneration over 2 or 3 weeks period. Neurologic examination showed the right internal and external ophthalmoplegia. Diagnostic studies (including laboratory testis, Tensilon test, brain MRI, and cerebral angiography) were normal. Serial brain SPECT studies with Tc-99m HMPAO showed the presence of reversible ischemia in the branches of the posterior cerebral artery.