Re: Oculomotor nerve tumors masquerading as recurrent painful ophthalmoplegic neuropathy.

Abstract

Dear Editor-in-Chief, Cephalalgia We read with interest the report by Kim et al. of two cases of oculomotor nerve schwannoma that mimicked recurrent painful ophthalmoplegic neuropathy (RPON), formerly known as ‘‘ophthalmoplegic migraine’’ (1). We recently published a case series of 10 patients with cranial nerve schwannomas that included two additional, previously unreported, cases of oculomotor nerve schwannoma mimicking RPON and an update on the first published case of this phenomenon (2,3). The authors stated that incomplete recovery from RPON should raise the possibility of a tumoral etiology (1). We wish to emphasize that schwannoma may be present even when recovery from RPON is complete. Also of interest is the fact that schwannomas may be found in painless relapsing ocular cranial nerve palsies (2). Because complete remission of symptoms, as present in our cases and initially in the authors’ cases, may occur, we suggest that schwannoma may be a more common mimicker of RPON than previously recognized and concur with the authors that serial magnetic resonance imaging (MRI) scans are essential to distinguish schwannoma from other causes, such as presumed transient inflammation.