Abstract

Objective Painful ophthalmoplegia includes nonspecific magnetic resonance imaging (MRI) manifestations and various clinical features including orbital pain and cranial nerve palsies. Treatment for painful ophthalmoplegia remains controversial. The aim of this report was to describe detailed clinical features, MRI findings, treatments, and prognosis of patients with painful ophthalmoplegia. Patients and Methods. We retrospectively investigated four cases of patients with painful ophthalmoplegia diagnosed using the International Classification of Headache Disorders, 3rd edition. Results All patients experienced unilateral orbital pain and oculomotor nerve palsy with diplopia but no vision loss. One of the four patients was diagnosed with Tolosa–Hunt syndrome based on the appearance of a granulomatous inflammation of the cavernous sinus on MRI. No specific lesions were detected on brain MRI for the other three patients; therefore, their headaches were attributed to ischaemic ocular motor nerve palsy. In all patients, a high-intensity ring appearance around the ipsilateral optic nerve was observed on MRI. Steroid therapy was administered to these patients, and good prognoses were anticipated. Conclusion These results indicate that prednisolone is a useful treatment for painful ophthalmoplegia that displays ipsilateral hyperintense ring lesions around the optic nerve on MRI, regardless of the presence of granulomatous inflammation of the cavernous sinus.

Highlights

  • Painful ophthalmoplegia is a pathologic condition caused by nonspecific inflammation of the cavernous sinus due to tumors, vasculitis, basal meningitis, neurosarcoidosis, or diabetes [1]

  • E International Classification of Headache Disorders, 3rd edition (ICHD-3), published in 2018, describes the diagnostic criteria of diseases applicable to painful ophthalmoplegia, including Tolosa–Hunt syndrome (THS), headache attributed to ischaemic ocular motor nerve palsy, and recurrent painful ophthalmoplegic neuropathy [2]

  • One patient was diagnosed with THS based on the appearance of granulomatous inflammation of the cavernous sinus on magnetic resonance imaging (MRI). e other three patients had no abnormal lesions of the cavernous sinus and were diagnosed with headache attributed to ischaemic ocular motor nerve palsy due to the existence of risk factors for microvascular ischemia based on ICHD-3

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Summary

Introduction

Painful ophthalmoplegia is a pathologic condition caused by nonspecific inflammation of the cavernous sinus due to tumors, vasculitis, basal meningitis, neurosarcoidosis, or diabetes [1]. It consists of periorbital or hemicranial pain with ipsilateral ocular motor nerve palsy and other cranial nerve palsies [1]. Due to the nonspecific nature of the inflammation, strategies for diagnosis, classifications, and treatment for painful ophthalmoplegia remain controversial. We present the cases of four patients with painful ophthalmoplegia diagnosed using ICHD-3 and describe the clinical features, MRI findings, and prognosis following considerable treatment

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