MRI Enhancing Ocular Motor Palsies

05 November 2004

Ocular Motor Palsies

412 patients:

Oculomotor:     172 cases

                        Ischemic, inflammatory, aneurysm most common

                        80% with aneurysms had fixed, dilated pupils

Abducens:        165 cases

                        Ischemic, inflammatory, tumor most common

Trochlear:         25 cases

                        Ischemic, inflammatory most common

Combined:        50 cases

                        Usually oculomotor & abducens

170 cases cause unknown

Ophthalmoplegic Migraine

Biggest case series is 8

Common migraine: pain & associated symptoms without aura

Incidence: 0.7/1,000,000

6/8 oculomotor palsy

            5/6 had pupillary involvement

4/8 had previously suffered migraine without aura

Bickerstaff definition: complete CN III palsy, nausea, vomiting, headache but excludes partial ophthalmoplegia sparing pupil

Other definitions: must have PHx or FHx of migraine

Biggest DDX is Tolosa-Hunt syndrome (some cases responsive to steroids)

Imaging (MRI with gad):  6 patients with enhancement of cisternal portion of  CN III

                        Recovery 3-6 weeks later

                        Enhancement disappeared with resolution of CN III palsy