Unit of Pediatrics and Pediatric Emergency, University Hospital "Policlinico Rodolico-San Marco", Catania, Italy.
Unit of Neonatal Intensive Care and Neonatology, University Hospital "Policlinico Rodolico-San Marco", Catania, Italy.
Ital J Pediatr. 2022 Jun 3;48(1):82. doi: 10.1186/s13052-022-01274-x.
Ophthalmoplegic migraine, renamed "Recurrent Painful Ophthalmoplegic Neuropathy" (RPON) in 2013 by the International Headache Society is a rare neurologic disorder characterized by recurrent attacks of ophthalmoplegia associated to ipsilateral headache. The etiology is still unknown. Typical magnetic resonance imaging findings show a focal nerve thickening and contrast enhancement. In the majority of cases, there is a full recovery within days or weeks. There is no evidence supporting a specific treatment. The review defines the characteristics of the recurrent painful ophthalmoplegic neuropathy in patients within 2 years of age underlying the importance of the role of magnetic resonance imaging even in presence of the first attack. Thus, an emblematic case report is presented.
The authors present a case of third cranial nerve paresis in a 17-month-old male child, presenting a neuroradiological pattern highly suggestive of schwannoma, aneurism or recurrent painful ophthalmoplegic neuropathy. Thus, a review of the literature with the pediatric casuistry of recurrent painful ophthalmoplegic neuropathy occurred within 2 years of age focusing on diagnostic considerations is presented. The authors highlight the importance to consider recurrent painful ophthalmoplegic neuropathy in presence of magnetic resonance imaging findings and clinical symptoms referable to aneurysm or schwannoma. Thus, the review defines the characteristics and the neuroradiological findings at the first RPON attack occurred under 2 years of age.
Although two attacks are necessary, the review strongly suggests to consider recurrent painful ophthalmoplegic neuropathy even at the first attack, in presence of described characteristics and the aforementioned magnetic resonance imaging findings.
眼肌麻痹性偏头痛，2013 年国际头痛学会更名为“复发性疼痛性眼肌神经病”（RPON），是一种罕见的神经系统疾病，其特征是反复发作的眼肌麻痹伴同侧头痛。病因仍不清楚。典型的磁共振成像表现为局灶性神经增粗和对比增强。大多数情况下，数天或数周内完全恢复。没有证据支持特定的治疗方法。该综述定义了 2 岁以下患者复发性疼痛性眼肌神经病的特征，即使在首次发作时，磁共振成像的作用也很重要。因此，提出了一个典型病例报告。
作者报告了一例 17 个月大男性患儿的第三颅神经麻痹，神经影像学模式高度提示神经鞘瘤、动脉瘤或复发性疼痛性眼肌神经病。因此，对 2 岁以下复发性疼痛性眼肌神经病的文献复习和儿科病例进行了回顾，重点讨论了诊断注意事项。作者强调了在存在磁共振成像发现和与动脉瘤或神经鞘瘤相关的临床症状时，考虑复发性疼痛性眼肌神经病的重要性。因此，该综述定义了 2 岁以下首次发生 RPON 的特征和神经影像学表现。
尽管需要两次发作，但即使在首次发作时，只要存在上述描述的特征和磁共振成像表现，该综述强烈建议考虑复发性疼痛性眼肌神经病。
