The Aetiology and Management of Long-Lasting Sixth Nerve Palsy in Ophthalmoplegic Migraine

Abstract

The features and management of two adult patients with ophthalmoplegic migraine and longlasting sixth nerve palsies are described. Both had had previous shorter episodes of diplopia following migraine-like headaches. One recovered following an injection of botulinum toxin to the medial rectus of her affected eye 11 months after the onset of diplopia. The other patient had previously had surgery for a consecutive divergent squint and required further squint surgery to realign his eyes 1 year after the onset of his sixth nerve palsy. Both botulinum toxin and squint surgery may be useful in the management of longstanding sixth nerve palsy in patients with ophthalmoplegic migraine. The aetiology of ophthalmoplegic migraine is discussed.

Recurrent painful ophthalmoplegic neuropathy: A report on the patient from the Romani population and 82-year-old patient

“…(15) The side of headache and nerve palsy is the same in the largest number of cases during different attacks of RPON (14), while the change of side is very rare, and Gelfand found only two cases in their series of 84 patients. (4) Alternating side of VI nerve palsy during different RPON episodes was described in a few cases (15,16) like alternating side of III nerve palsy. (15) Only 1-6.5% of patient had symptoms on different side in two different attacks like our first patient.…”

Monocular diplopia‐associated migraine‐like headache induced by nicotine withdrawal

“…Diplopia‐associated migraine is often classified under the subtype of ophthalmoplegic migraines (OM) which has been renamed “recurrent painful ophthalmoplegic neuropathy” (RPON) in the third edition of the International Classification of Headache Disorders (ICHD) . OM or RPON is a rare disorder, with a prevalence of 0.7 per one million . It typically starts in childhood, but adult onset cases have also been reported .…”

“…It typically starts in childhood, but adult onset cases have also been reported . Hallmarks of this disorder are defined as “recurrent attacks of headache with migrainous characteristics associated with paresis of one or more ocular cranial nerves (commonly the third nerve) in the absence of any demonstrable intracranial lesion other than MRI changes within the affected nerve .” Although most previous reports have not distinguished between monocular and binocular diplopia in OM, diplopia in OM generally represents a failure of binocular fusion of vision secondary to dysfunction of ocular motor nerve, which is typically binocular viewing.…”

Pediatric Cranial Nerve Palsies

“…Uncommon causes of childhood sixth nerve palsies reported in the literature include ophthalmoplegic migraine, 97 infantile botulism, 98 intracranial hypotension, iatrogenic causes including lumbar puncture (LP) or myelography, 99,100 and Gradenigo syndrome. 101,102 Sixth nerve injury following LP is felt to be secondary to displacement of the brain after decrease in cerebrospinal fluid volume.…”