Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A 56-year-old woman with adult-onset ophthalmoplegic migraine presenting with recurrent bilateral abducens nerve palsy

Ayaka Numao, M.D.1), Keisuke Suzuki, M.D., Ph.D.1), Yuka Watanabe, M.D., Ph.D.1), Naoki Izawa, M.D.1), Toshiki Nakamura, M.D., Ph.D.2), Hisatake Iwanami, M.D., Ph.D.1) and Koichi Hirata, M.D., Ph.D.1)

1)Department of Neurology, Dokkyo Medical University
2)Department of Neurology, Rehabilitation Amakusa Hospital

A 56-year-old woman had been experiencing episodic left eye pain followed within 3 days by double vision and adduction of the left eye since the age of 30. The episodes occurred once per month, and her symptoms spontaneously resolved within 3 days. The patient was diagnosed with ophthalmoplegic migraine (OM) with left abducens nerve palsy at the age of 53 years. In May 2011, she developed bilateral retro-orbital pain followed by double vision and limitation of abduction of the right eye. She recalled having a cold and high fever 10 days before the onset of the headache. MRI showed no thickening or enhancement of the right abducens nerve. Constructive interference in steady-state (CISS) MRI showed neurovascular contact between the right abducens nerve and anterior inferior cerebellar artery. Right abducens nerve palsy accompanied by OM was diagnosed after other diseases that can cause ophthalmoplegia were excluded. The patient's eye symptoms gradually improved following steroid treatment. There have been a few similar case reports of adult patients with OM showing left and right abducens nerve palsy at different time points. In this case report, we discuss the possible mechanisms related to OM.
Full Text of this Article in Japanese PDF (613K)

(CLINICA NEUROL, 52: 239|244, 2012)
key words: ophthalmoplegic migraine, adult-onset, recurrent bilateral abducens nerve palsy, neurovascular compression

(Received: 26-Jul-11)