A possible explanation of the mechanism of ophthalmoplegic migraine

Walsh, James P.; O'Doherty, Desmond S.

doi:10.1212/wnl.10.12.1079

Cited by 123 publications

(58 citation statements)

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“…Some have proposed vascular dilatation (perhaps posterior cerebral artery) with compression of the third cranial nerve. Walsh and O'Doherty [9] suggested cavernous carotid artery enlargement with compression of intracavernous cranial nerves. However, negative arteriography has argued against this [6].…”

Section: Discussionmentioning

confidence: 99%

Ophthalmoplegic migraine

Levin

Ward

2004

Current Science Inc

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Ophthalmoplegic migraine is a rare condition, previously thought to represent a variant of migraine. Recent observations regarding its usual clinical presentation and common magnetic resonance imaging findings have given rise to speculation that this illness is more likely to represent an inflammatory cranial neuropathy. The recent revision of the International Headache Classification has reclassified ophthalmoplegic migraine from a subtype of migraine to the category of neuralgia. In this article, potential pathophysiological mechanisms are discussed. The typical clinical presentation of ophthalmoplegic migraine generally involves transient migraine-like headache accompanied by often long-lasting oculomotor, abducens or, rarely, trochlear neuropathy with diplopia and (if oculomotor nerve is involved) pupillary abnormalities and ptosis. Ophthalmoplegic migraine generally occurs in children, but a number of adult cases have been reported. Prognosis is good because symptoms almost always resolve, but, after several episodes, some deficits may persist. Differential diagnosis is rather large, although most other possible causes of ophthalmoplegia and headache have distinctive presentations or can be excluded with fairly straightforward diagnostic testing. Optimal prophylactic and acute treatment is still unclear, but migraine prophylactic medications such as b blockers and calcium channel blockers have been proposed. Steroids have been used with mixed results.

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Section: Discussionmentioning

confidence: 99%

Ophthalmoplegic migraine

Levin

Ward

2004

Current Science Inc

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“…Arteries which are seen to be narrowed at angiography may be normal histologically [113]. Primary, 'spontaneous' vasospasm probably occurs in migraine, but when angiograms have been performed during, or after a migraine attack, such appearances have not been seen; they reveal narrowing of the internal carotid artery either in its extradural [114,135] or intracavernous part [136]. Coronary artery spasm is now a recognized cause of symptoms of myo cardial ischaemia [137].…”

Section: Pathophysiologymentioning

confidence: 99%

Isolated Angiitis/Angiopathy of the Central Nervous System

Hankey¹

1990

Cerebrovasc Dis

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One hundred cases of isolated angiopathy of the central nervous system (CNS) have been described, the majority of whom (71%) were diagnosed histologically. The pathological findings were those of angiitis, most frequently granulomatous angiitis. These patients should be classified as isolated angiitis of the CNS. The minority of patients (29%) were diagnosed according to clinical and angiographic findings which lack sensitivity and specificity. They represent a heterogeneous group, comprising several cases of probable isolated angiitis of the CNS, some clinical and angiographic syndromes associated with acute hypertension, subarachnoid haemorrhage or migraine and other more obscure ''entities'' such as post-partum cerebral angiopathy and isolated benign cerebral angiopathy. In the absence of a histological diagnosis, it is preferable to classify them as isolated angiopathy of the CNS. Although isolated angiitis of the CNS can be considered a discrete, or at least definable, subset of isolated angiopathy of the CNS, it is unclear whether it is a specific disorder or part of a spectrum of disease or even one of a number of reactions to various antigens. The finding of granulomatous angiitis of the CNS (GACNS) in several patients with various systemic disorders suggests that GACNS may be a non-specific pathological reaction. Until the last decade, the prognosis of isolated angiitis of the CNS was extremely poor. Most patients now survive and return to active lives. The major influence on outcome appears to have been the use of combination corticosteroid and cyclophosphamide therapy, although no randomized controlled trials have been undertaken. Before prolonged treatment with such potent medication is prescribed, it recommended that other causes of CNS vasculitis be carefully excluded and the diagnosis of isolated angiitis of the CNS be established histologically by combined leptomeningeal and parenchymal biopsy. The risks of biopsy would not appear to exceed those of untreated isolated angiitis of the CNS. Multicentre collaboration of interested groups should be encouraged if controlled therapeutic trials are to be achieved.

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“…The syndrome of severe unilateral facial pain with recurrent 3rd nerve palsy is typical of ophthalmoplegic migraine (Walsh and O'Doherty, 1960), but before this diagnosis is made a sphenoidal mucocoele should be excluded. Jefferson (1947) found that 55 aneurysms out of total 158 caused isolated paralysis of the oculomotor nerve, but in such a case the recovery after a single episode is never as complete as in ophthalmoplegic migraine or in mucocoele.…”

Section: Case 2 (3727)mentioning

confidence: 99%