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Bilateral persistent ophthalmoplegia in a patient with migraine: persistent migraine aura without infarction?
  1. Sanjay Prakash1,
  2. Anurag Prakash2 and
  3. Deepali Lodha3
  1. 1Neurology, SBKS Medical Institute and Research Centre, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
  2. 2Parul University Parul Institute of Medical Sciences and Research, Vadodara, Gujarat, India
  3. 3Department of Medicine, Smt BK Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Waghodia, Gujarat, India
  1. Correspondence to Sanjay Prakash; drprakashs{at}


Migraine auras typically last for 5–60 min. An aura that persists for more than a week without evidence of infarction on neuroimaging is called persistent aura without infarction. Persistent migraine aura without infarction is usually described with visual auras. Herein, we are reporting a 24-year-old man who had an attack of a headache with diplopia, vertigo and tinnitus. Tinnitus and vertigo disappeared within 30 min. The headache also disappeared within 6 hours. However, diplopia and ophthalmoplegia persisted for 4 weeks. Secondary causes of bilateral ophthalmoplegia were ruled out by a proper history, clinical examinations and appropriate investigations. A trial with lamotrigine and sodium valproate led to the complete improvement in ophthalmoplegia within 2 weeks. We considered ophthalmoplegia in this patient as ‘persistent brainstem aura without infarction’. We suggest that a possibility of persistent migraine aura without infarction should be considered in all migraineurs who have unexplained and persistent neurological symptoms.

  • headache (including migraines)
  • neuro-opthalmology

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  • Contributors SP and AP were involved in the conception and design. SP and DL were involved in the acquisition of data. SP was involved in the manuscript preparation. AP and DL were involved in revising the draft for intellectual content. All authors approved the final version of this manuscript. SP was the guarantor.

  • 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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