flunarizine and Dilatation--Pathologic

Ophthalmoplegic migraine (OM) is a childhood disorder of uncertain etiology manifesting recurrent unilateral headache associated with a transitory oculomotor (usually IIIrd nerve) palsy. Recent publications emphasize the finding on MRI of contrast enhancement in the IIIrd nerve suggesting that OM may be a recurrent inflammatory neuropathy. We report the case of a 7-year-old boy with typical symptoms of this disorder. Angio MR and Angio CT revealed the presence of an infundibular dilatation of a perforating branch of the posterior cerebral artery adjacent to the symptomatic IIIrd nerve. We speculate that this and perhaps other cases of OM may have a different pathophysiology related to compression of the IIIrd nerve by an adjacent vascular structure that could activate the trigeminovascular system and produce migrainous pain.

Topics: Age of Onset; Anti-Inflammatory Agents; Cerebral Arterial Diseases; Child; Child, Preschool; Dilatation, Pathologic; Flunarizine; Humans; Infant; Magnetic Resonance Imaging; Male; Migraine Disorders; Oculomotor Nerve Diseases; Ophthalmoplegia; Prednisone; Radiography; Vasodilator Agents