Answer for BIR CoW 22 Jun 2025
Opthalmoplegic migrane
Findings
Evidence of T2 hypointense nodular enhancing thickening involving distal cisternal segment of right 3rd nerve with maximum thickness 4mm.
Discussion
Ophthalmoplegic migraine or migrainous ophthalmoplegia is a type of cranial neuralgia. It is a poorly understood entity that involves recurrent episodes of headache with opthalmoplegia. The etiology is unclear but may involve acute bouts of nerve demyelination
Clinical Presentation: Episodes may be recurrent and may present with headache with ophthalmoplegia caused by involvement of cranial nerves III, IV, and VI. The oculomotor nerve is most commonly involved. Headaches may or may not be migraine-like. Predominantly affects the pediatric population and young adults Symptoms may last from hours-to-weeks or may be permanent
Key Diagnostic Features: Focal thickening and enhancement of the affected cranial nerve(s) on MRI is demonstrated. Typically, the root exit zone of the oculomotor nerve is affected. Both thickening and enhancement may persist, but enhancement usually diminishes or resolves
Differential Diagnosis: Cranial nerve schwannoma/neuroma Lymphoma Sarcoidosis and other infiltrative cranial neuropathies
Treatment: Symptoms may spontaneously resolve. Corticosteroid therapy has been reported to result in reduction in symptom duration and quicker recovery
Findings
Evidence of T2 hypointense nodular enhancing thickening involving distal cisternal segment of right 3rd nerve with maximum thickness 4mm.
Discussion
Ophthalmoplegic migraine or migrainous ophthalmoplegia is a type of cranial neuralgia. It is a poorly understood entity that involves recurrent episodes of headache with opthalmoplegia. The etiology is unclear but may involve acute bouts of nerve demyelination
Clinical Presentation: Episodes may be recurrent and may present with headache with ophthalmoplegia caused by involvement of cranial nerves III, IV, and VI. The oculomotor nerve is most commonly involved. Headaches may or may not be migraine-like. Predominantly affects the pediatric population and young adults Symptoms may last from hours-to-weeks or may be permanent
Key Diagnostic Features: Focal thickening and enhancement of the affected cranial nerve(s) on MRI is demonstrated. Typically, the root exit zone of the oculomotor nerve is affected. Both thickening and enhancement may persist, but enhancement usually diminishes or resolves
Differential Diagnosis: Cranial nerve schwannoma/neuroma Lymphoma Sarcoidosis and other infiltrative cranial neuropathies
Treatment: Symptoms may spontaneously resolve. Corticosteroid therapy has been reported to result in reduction in symptom duration and quicker recovery
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!