[P1-216] A Pediatric Case with Recurrent Painful Ophthalmoplegic Neuropathy
Recurrent painful ophthalmoplegic neuropathy (RPON), previously named ophthalmoplegic migraine (OM) is a rare entity characterized by recurrent unilateral headache accompanied or followed by ipsilateral ophthalmoplegia. We report a child with recurrent oculomotor nerve palsy as a manifestation of OM. A 6-year-old girl admitted to our emergency room with severe and progressive pain in the right fronto-orbital region and photophobia for the previous 5 days. Neurological examination revealed ptosis and exodeviation of the right eye with ipsilateral midriasis and paresis of the left, upward, and downward gaze. She had a history of otitis media infection 2 weeks ago. The parents reported one similar episode at the age of 2 years, which resolved within 4 weeks after onset without any treatment. Laboratory tests including routine hematology and biochemistry tests, erythrocyte sedimentation rate were normal. A through evaluation of cerebrospinal fluid including cytology, viral infections, Lyme disease, oligoclonal band were also negative. Brain magnetic resonance imaging (MRI) with gadolinium revealed contrast enhancement and focal thickening of the right oculomotor nerve in its cisternal portion. Headache resolved within 7 days and oculomotor palsy resolved over 3-4 weeks. We started flunarizin for migraine prophylaxis. Ophtalmoplegic migraine in childhood is a rare presentation of migraine. The etiology of RPON remains unclear; different mechanisms including ischemic, inflammatory and immunological have been suggested. Recurrent and reversible painful ophtalmoplegia together with typical neuroimaging features facilitate the diagnosis.