Denouement and Discussion
Ophthalmoplegic Migraine
Manifestations
Ophthalmoplegia is a rare complication of migraine. The onset of ophthalmoplegic migraine is usually before 10 years of age. The most common manifestation is partial to total paralysis of the oculomotor nerve. Paralysis of the abducens nerve occurs less frequently. In the usual case, within 12 to 24 hours after an episode of headache and vomiting, there is sudden onset of ptosis, dilatation of the pupil which reacts either sluggishly or is fixed, and an inability to look inward, upward, and downward. In practically all cases the paralysis improves within one to three weeks. Single or multiple episodes may occur and after several attacks, permanent neurologic deficit may result. This deficit varies from a large and slowly reacting pupil to total oculomotor nerve paralysis.Differential diagnosis includes intracranial aneurysm, myasthenia gravis, polyneuritis cranialis, and intracranial tumors. Of these, intracranial aneurysm is the most likely