Recurrent painful ophthalmoplegic neuropathy: MRI findings in 2 patients

Sharifi, Arghavan; Kayfan, Samar; Clarke, Rebekah; Mehta, Akshita; Pfeifer, Cory M.

doi:10.1016/j.radcr.2019.05.029

Cited by 10 publications

(22 citation statements)

References 10 publications

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“…Consistently, several other similar cases have been reported recently. The image feature of these patients on MRI with contrast was quite similar to that in the present study (6,13). Additionally, our case also displayed an obvious signal change in the affected nerve on DWI and ADC maps during the episode compared to that during remission.…”

Section: Discussionsupporting

confidence: 85%

A Case of Recurrent Painful Ophthalmoplegic Neuropathy

et al. 2020

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Ophthalmoplegic migraine (OM) is characterized by recurrent episodes of headache with unilateral ophthalmoplegia due to paresis of cranial nerve III, IV, or VI. The recent revision to the International Headache Classification has reclassified it as recurrent painful ophthalmoplegic neuropathy (RPON). However, it is of note that the presentation of oculomotor nerve tumors may mimic RPON. Here, we report the case of a patient presenting with recurrent migraine and oculomotor palsy with several specific magnetic resonance imaging (MRI) findings. The patient was initially diagnosed with migraine 15 years ago, but since 10 years ago, his symptoms had evolved to include repeated oculomotor paralyzes. Before this attack, the patient did eventually recover completely each time after the initial episode. MRI performed during this attack revealed a nodular enhancing lesion described as schwannoma of the left oculomotor nerve, and on diffusion-weighted imaging (DWI), the nerve was isointense to the midbrain. The nodular enhancement became weaker, and the nerve's signal on DWI disappeared 3 months later as the patient's symptoms resolved mostly. This is the first case of RPON demonstrating an obvious change in signal of the affected nerve on DWI during the attack and remission.

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Section: Discussionsupporting

confidence: 85%

A Case of Recurrent Painful Ophthalmoplegic Neuropathy

et al. 2020

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“…Third nerve thickening and post-contrast enhancement are suggestive of oculomotor nerve schwannoma, carcinomatosis, granulomatosis, in ammatory or infectious neuritis (10). The case presented was from the beginning highly suggestive for RPON but MRI ndings still have no relevance in the diagnostic criteria.…”

Section: Discussionmentioning

confidence: 85%

Recurrent Painful Ophthalmoplegic Neuropathy: Diagnostic Controversies. Single Case Report with a Systematic Review

Falsaperla

Presti

Bianco

et al. 2021

Preprint

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Background: Ophthalmoplegic migraine, renamed “Recurrent Painful Ophthalmoplegic Neuropathy (RPON) in 2013 by the International Headache Society is a rare neurologic disorder characterized by recurrent attacks of ophthalmoplegia associated to ipsilateral headache. The etiology is still unknown. Typical magnetic resonance imaging findings show a focal nerve thickening and contrast enhancement. In the majority of cases, there is a full recovery within days or weeks. There is no evidence supporting a specific treatment. The review defines the characteristics of the recurrent painful ophthalmoplegic neuropathy in patients within 2 years of age underlying the importance of the role of magnetic resonance imaging even in presence of the first attack. Thus, an emblematic case report is presented.Case presentation: The authors present a case of third cranial nerve paresis in a 17-month-old male child, presenting a neuroradiological pattern highly suggestive of schwannoma, aneurism or recurrent painful ophthalmoplegic neuropathy. Thus, a review of the literature with the pediatric casuistry of recurrent painful ophthalmoplegic neuropathy occurred within 2 years of age focusing on diagnostic considerations is presented. The authors highlight the importance to consider recurrent painful ophthalmoplegic neuropathy in presence of magnetic resonance imaging findings and clinical symptoms referable to aneurysm or schwannoma. Thus, the review defines the characteristics and the neuroradiological findings at the first RPON attack occurred under 2 years of age.Conclusion: Although two attacks are necessary, the review strongly suggests to consider recurrent painful ophthalmoplegic neuropathy even at the first attack, in presence of described characteristics and the aforementioned magnetic resonance imaging findings.

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“…As shown in Table 1, the demographic and medical characteristics of the cases in our clinic along with the reported cases from other studies that were diagnosed as OM or RPON from 2000 to 2020 were reviewed (4–6,9–15,19–59). From the database, most reported cases were from the USA, India, Japan, and European countries (e.g.…”

Section: Resultsmentioning

confidence: 99%

Proposed modified diagnostic criteria for recurrent painful ophthalmoplegic neuropathy: Five case reports and literature review

et al. 2020

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Background Recurrent painful ophthalmoplegic neuropathy (RPON) is an uncommon disorder characterized by recurrent unilateral headache attacks associated with ipsilateral ophthalmoplegia. We intend to study the clinical picture in our case series along with the published literature to discuss the pathogenesis and propose modified diagnostic criteria for recurrent painful ophthalmoplegic neuropathy. Methods We reported five cases diagnosed as ophthalmoplegic migraine/RPON in our medical centers and reviewed the published literature related to RPON from the Pubmed database between 2000 and 2020. In one of these cases, a multiplanar reformation was performed to look at the aberrant cranial nerve. Results The mean onset age for RPON was 22.1 years, and the oculomotor nerve was the most commonly involved cranial nerve (53.9%) in 165 reviewed patients. In most patients, ophthalmoplegia started within 1 week of the headache attack (95.7%, 67/70). Additionally, 27.6% (40/145) of patients presented enhancement of the involved nerve(s) from MRI tests. Finally, 78 patients received corticosteroids, out of which 96.2% benefited from them. Conclusion This is the first time multiplanar reformation has been performed to reveal the distortion of the oculomotor nerve. Modified diagnostic criteria are proposed. We hope to expand the current knowledge and increase the detection of recurrent painful ophthalmoplegic neuropathy in the future.

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Recurrent painful ophthalmoplegic neuropathy: MRI findings in 2 patients

Cited by 10 publications

References 10 publications

A Case of Recurrent Painful Ophthalmoplegic Neuropathy

A Case of Recurrent Painful Ophthalmoplegic Neuropathy

Recurrent Painful Ophthalmoplegic Neuropathy: Diagnostic Controversies. Single Case Report with a Systematic Review

Proposed modified diagnostic criteria for recurrent painful ophthalmoplegic neuropathy: Five case reports and literature review

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