Source
Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Abstract
PURPOSE:
To present 2 children with ophthalmoplegic migraine and characteristic magnetic resonance imaging (MRI) findings post enhancement with gadopentetate dimeglumine diethylenetriamine pentaacetic acid (Gd-DTPA).
METHODS:
Two patients, ages 3 years and 7 years, underwent MRI during the acute phases of a recurring oculomotor palsy. MRI was repeated several weeks later as symptoms resolved.
RESULTS:
In both cases, enhancement and thickening of the cisternal segment of the oculomotor nerve were present at initial presentation. Ophthalmoplegia resolved spontaneously in 1 child and after steroid treatment in the other. Both postresolution MRIs demonstrated decrease in enhancement and thickening of the third nerve.
CONCLUSIONS:
The enhancing, thickened lesion identified on MRI in our patients may represent an inflammatory process similar to Tolosa-Hunt syndrome occurring in the interpeduncular segment of the oculomotor nerve. Patients with ophthalmoplegic migraine may, therefore, benefit from the use of steroids. MRI of the brain post enhancement is a useful adjunct in the diagnosis and treatment of ophthalmoplegic migraine and should be considered as part of a workup of ophthalmoplegic migraine in children.