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Steroid-Responsive Ophthalmoplegia in a Child: Diagnostic Considerations

Steroid-Responsive Ophthalmoplegia in a Child: Diagnostic Considerations Abstract • Among the painful ophthalmoplegias, ophthalmoplegic migraine and Tolosa-Hunt syndrome share many features. Our 6-year-old patient had three episodes of ophthalmoplegia. Two episodes were painful and promptly resolved with oral prednisone. She had no evidence of parasellar or systemic disease. A review of published cases of ophthalmoplegic migraine demonstrated that the clinical history, the cornerstone of diagnosis in migraine, does not differentiate ophthalmoplegic migraine from Tolosa-Hunt syndrome. Other features helpful in the diagnosis of Tolosa-Hunt syndrome were not usually investigated in reports of ophthalmoplegic migraine. Until better criteria are available for differentiating the two entities, we suggest that children who fulfill the clinical criteria for Tolosa-Hunt syndrome receive a trial of steroid therapy. References 1. Walsh JP, O'Doherty DS: A possible explanation of the mechanism of ophthalmoplegic migraine . Neurology 1960;10:1079-1084.Crossref 2. Kline LB: The Tolosa-Hunt syndrome . Surv Ophthalmol 1982;27:79-95.Crossref 3. Hunt WE, Meagher JN, LeFever HE, et al: Painful ophthalmoplegia: Its relation to indolent inflammation of the cavernous sinus . Neurology 1961;11:56-62.Crossref 4. Hunt WE: Tolosa-Hunt syndrome: One cause of painful ophthalmoplegia . J Neurosurg 1976;44:544-549.Crossref 5. Friedman AP, Harter DH, Merritt HH: Ophthalmoplegic migraine . Arch Neurol 1962; 7:320-327.Crossref 6. DeRenzi E, Nichelli P: Ophthalmoplegic migraine with persistent abducens nerve palsy . Eur Neurol 1977;15:227-230.Crossref 7. Pearce J: The ophthalmological complications of migraine . J Neurol Sci 1968;6:73-81.Crossref 8. Lincoff HA, Cogan DG: Unilateral headache and oculomotor paralysis not caused by aneurysm . Arch Ophthalmol 1957;57:181-189.Crossref 9. Vijayan N: Ophthalmoplegic migraine: Ischemic or compressive neuropathy? Headache 1980;20:300-304.Crossref 10. Kettler HL: Tolosa-Hunt syndrome or ophthalmoplegic migraine? Reply from the authors . Neurology 1976;26:598-599.Crossref 11. Alpers BJ, Yaskin HE: Pathogenesis of ophthalmoplegic migraine . Arch Ophthalmol 1951;45:555-566.Crossref 12. Andersson PG: Ophthalmoplegic migraine . Headache 1974;14:91-95.Crossref 13. Cruciger MP, Mazow ML: An unusual case of ophthalmoplegic migraine . Am J Ophthalmol 1978;86:414-417. 14. Durkan GP, Troost BT, Slamovits TL, et al: Recurrent painless oculomotor palsy in children: A variant of ophthalmoplegic migraine? Headache 1981;21:58-62.Crossref 15. Lepore FE, Glaser JS: Misdirection revisited: A critical appraisal of acquired oculomotor nerve synkinesis . Arch Ophthalmol 1980;98:2206-2209.Crossref 16. Miller NR: Solitary oculomotor nerve palsy in childhood . Am J Ophthalmol 1977;83:106-111. 17. O'Day J, Billson F, King J: Ophthalmoplegic migraine and aberrant regeneration of the oculomotor nerve . Br J Ophthalmol 1980;64:534-536.Crossref 18. Osuntokun O, Osuntokun BO: Ophthalmoplegic migraine and hemoglobinopathy in Nigerians . Am J Ophthalmol 1972;740:451-455. 19. Rabey JM, Vardi Y, Van Dyck D, et al: Ophthalmoplegic migraine: Amelioration by flufenamic acid, a prostaglandin inhibitor . Ophthalmologica 1977;175:148-152.Crossref 20. Raymond LA, Tew J, Fogelson MH: Ophthalmoplegic migraine of early onset . J Pediatr 1977;90:1035-1036.Crossref 21. Robertson WC, Schnitzler ER: Ophthalmoplegic migraine in infancy . Pediatrics 1978; 61:886-888. 22. Van Pelt W, Andermann F: On the early onset of ophthalmoplegic migraine . AJDC 1964; 107:628-631. 23. VerBrugghen A: Pathogenesis of ophthalmoplegic migraine . Neurology 1955;5:311-318.Crossref 24. Whitehouse PJ, Bleecker ML: Co-occurring ophthalmoplegia and hemiparesis in a case of migraine . Arch Neurol 1982;39:445-446.Crossref 25. Schatz NJ, Farmer P: Tolosa-Hunt syndrome: The pathology of painful ophthalmoplegia , in Smith JL (ed): Neuro-ophthalmology Symposium of the University of Miami and the Bascom Palmer Eye Institute . St Louis, CV Mosby Co, 1972, vol 6, pp 102-112. 26. Takeoka T, Gotoh F, Fukuuchi Y, et al: Tolosa-Hunt syndrome: Arteriographic evidence of improvement in carotid narrowing . Arch Neurol 1978;35:219-223.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Steroid-Responsive Ophthalmoplegia in a Child: Diagnostic Considerations

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Publisher
American Medical Association
Copyright
Copyright © 1985 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1985.04060060095016
Publisher site
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Abstract

Abstract • Among the painful ophthalmoplegias, ophthalmoplegic migraine and Tolosa-Hunt syndrome share many features. Our 6-year-old patient had three episodes of ophthalmoplegia. Two episodes were painful and promptly resolved with oral prednisone. She had no evidence of parasellar or systemic disease. A review of published cases of ophthalmoplegic migraine demonstrated that the clinical history, the cornerstone of diagnosis in migraine, does not differentiate ophthalmoplegic migraine from Tolosa-Hunt syndrome. Other features helpful in the diagnosis of Tolosa-Hunt syndrome were not usually investigated in reports of ophthalmoplegic migraine. Until better criteria are available for differentiating the two entities, we suggest that children who fulfill the clinical criteria for Tolosa-Hunt syndrome receive a trial of steroid therapy. References 1. Walsh JP, O'Doherty DS: A possible explanation of the mechanism of ophthalmoplegic migraine . Neurology 1960;10:1079-1084.Crossref 2. Kline LB: The Tolosa-Hunt syndrome . Surv Ophthalmol 1982;27:79-95.Crossref 3. Hunt WE, Meagher JN, LeFever HE, et al: Painful ophthalmoplegia: Its relation to indolent inflammation of the cavernous sinus . Neurology 1961;11:56-62.Crossref 4. Hunt WE: Tolosa-Hunt syndrome: One cause of painful ophthalmoplegia . J Neurosurg 1976;44:544-549.Crossref 5. Friedman AP, Harter DH, Merritt HH: Ophthalmoplegic migraine . Arch Neurol 1962; 7:320-327.Crossref 6. DeRenzi E, Nichelli P: Ophthalmoplegic migraine with persistent abducens nerve palsy . Eur Neurol 1977;15:227-230.Crossref 7. Pearce J: The ophthalmological complications of migraine . J Neurol Sci 1968;6:73-81.Crossref 8. Lincoff HA, Cogan DG: Unilateral headache and oculomotor paralysis not caused by aneurysm . Arch Ophthalmol 1957;57:181-189.Crossref 9. Vijayan N: Ophthalmoplegic migraine: Ischemic or compressive neuropathy? Headache 1980;20:300-304.Crossref 10. Kettler HL: Tolosa-Hunt syndrome or ophthalmoplegic migraine? Reply from the authors . Neurology 1976;26:598-599.Crossref 11. Alpers BJ, Yaskin HE: Pathogenesis of ophthalmoplegic migraine . Arch Ophthalmol 1951;45:555-566.Crossref 12. Andersson PG: Ophthalmoplegic migraine . Headache 1974;14:91-95.Crossref 13. Cruciger MP, Mazow ML: An unusual case of ophthalmoplegic migraine . Am J Ophthalmol 1978;86:414-417. 14. Durkan GP, Troost BT, Slamovits TL, et al: Recurrent painless oculomotor palsy in children: A variant of ophthalmoplegic migraine? Headache 1981;21:58-62.Crossref 15. Lepore FE, Glaser JS: Misdirection revisited: A critical appraisal of acquired oculomotor nerve synkinesis . Arch Ophthalmol 1980;98:2206-2209.Crossref 16. Miller NR: Solitary oculomotor nerve palsy in childhood . Am J Ophthalmol 1977;83:106-111. 17. O'Day J, Billson F, King J: Ophthalmoplegic migraine and aberrant regeneration of the oculomotor nerve . Br J Ophthalmol 1980;64:534-536.Crossref 18. Osuntokun O, Osuntokun BO: Ophthalmoplegic migraine and hemoglobinopathy in Nigerians . Am J Ophthalmol 1972;740:451-455. 19. Rabey JM, Vardi Y, Van Dyck D, et al: Ophthalmoplegic migraine: Amelioration by flufenamic acid, a prostaglandin inhibitor . Ophthalmologica 1977;175:148-152.Crossref 20. Raymond LA, Tew J, Fogelson MH: Ophthalmoplegic migraine of early onset . J Pediatr 1977;90:1035-1036.Crossref 21. Robertson WC, Schnitzler ER: Ophthalmoplegic migraine in infancy . Pediatrics 1978; 61:886-888. 22. Van Pelt W, Andermann F: On the early onset of ophthalmoplegic migraine . AJDC 1964; 107:628-631. 23. VerBrugghen A: Pathogenesis of ophthalmoplegic migraine . Neurology 1955;5:311-318.Crossref 24. Whitehouse PJ, Bleecker ML: Co-occurring ophthalmoplegia and hemiparesis in a case of migraine . Arch Neurol 1982;39:445-446.Crossref 25. Schatz NJ, Farmer P: Tolosa-Hunt syndrome: The pathology of painful ophthalmoplegia , in Smith JL (ed): Neuro-ophthalmology Symposium of the University of Miami and the Bascom Palmer Eye Institute . St Louis, CV Mosby Co, 1972, vol 6, pp 102-112. 26. Takeoka T, Gotoh F, Fukuuchi Y, et al: Tolosa-Hunt syndrome: Arteriographic evidence of improvement in carotid narrowing . Arch Neurol 1978;35:219-223.Crossref

Journal

Archives of Neurology – American Medical Association

Published: Jun 1, 1985

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