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Recurrent painful ophthalmoplegic neuropathy: a cause for recurrent third nerve palsy in a child
  1. Jayakumari Nandana1,
  2. Sruthi S Nair1,
  3. Sachin Girdhar2 and
  4. Soumya Sundaram3
  1. 1Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
  2. 2Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
  3. 3Pediatric Neurology and Neurodevelopmental disorders, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
  1. Correspondence to Dr Soumya Sundaram; ssdr.soumya{at}gmail.com

Abstract

Recurrent painful ophthalmoplegic neuropathy (RPON), previously called ophthalmoplegic migraine, is a rare condition characterised by recurrent episodes of headache and ophthalmoplegia. We report a case of 11-year-old girl with recurrent painful ophthalmoplegia due to isolated right oculomotor nerve involvement. MR brain imaging showed enhancing lesion of cisternal segment of right oculomotor nerve. A possibility of Tolosa Hunt syndrome was considered and she was treated with glucocorticoids, followed by azathioprine due to recurrence. In the fourth episode, she developed migraine headache followed by right third nerve palsy, after which the diagnosis was revised to RPON. She was started on flunarizine along with short-term glucocorticoids. At 1-year follow-up, she remained asymptomatic. RPON should be considered in patients with recurrent third nerve palsy to avoid inadvertent long-term exposure to immunosuppressive agents.

  • paediatrics (drugs and medicines)
  • cranial nerves
  • neuroopthalmology

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Footnotes

  • Contributors JN: study concept, study design, acquisition of data and drafting of manuscript. SSN: critical revision and supervision of manuscript. SG: acquisition of data and drafting of manuscript. SS: study concept, design, supervision and critical revision of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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