Ophthalmoplegia With Migraine in Adults: Is It Ophthalmoplegic Migraine?
Ophthalmoplegia With Migraine in Adults: Is It Ophthalmoplegic Migraine?
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DOI：
10.1111/j.1526-4610.2009.01405.x
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发表时间：
2009-06-01
期刊：
影响因子：
5
通讯作者：
Prabhakar, Sudesh
中科院分区：
文献类型：
--
作者：
Lal, Vivek;Sahota, Preeti;Prabhakar, Sudesh
眼肌麻痹性偏头痛（OM）是一种罕见的疾病，其特征是儿童偏头痛后复发性眼神经麻痹。我们报告了62名成年人，连续观察，他们在10年（1996-2005）的时间里发生了急性眼肌麻痹伴严重偏头痛发作。这些患者中绝大多数在眼肌麻痹发作之前，偏头痛的严重程度就已经恶化。62例年龄在15-68岁的OM急性发作患者进行了详细的临床、生化和神经放射学评估。48例患者有一次发作，14例有2次或2次以上发作，分别符合国际头痛协会关于可能和明确OM的标准。临床表现为孤立性外展神经、眼神经和滑车神经受累的患者分别为35例（56.5%）、21例（33.9%）和5例（8.1%）。1例患者同时累及第3和第6神经。51例（82.3%）患者分别在重度偏头痛发作期间（59/95.2%）或24小时内（3/4.8%）发生眼肌麻痹之前，表现出偏头痛严重程度的前期恶化。详细的生物化学和颅神经成像正常。无一例神经强化。我们的结论是：（1）成人OM的特点是绝大多数患者的眼肌麻痹是单次发作;（2）第6神经受累是常见的。我们的研究结果表明，在国际头痛分类第二版中将OM移到颅神经痛章节可能为时过早，因为所有患者在严重偏头痛发作期间都发生了神经麻痹。
Ophthalmoplegic migraine (OM) is a rare disorder characterized by recurrent oculomotor nerve palsy in children, following migraine headaches. We report 62 adults, seen consecutively, who developed acute ophthalmoplegia with severe attacks of migraine over a 10-year (1996-2005) period. An overwhelming majority of these patients had an antecedent worsening in severity of migraine headaches, before the ophthalmoplegic attack.Sixty-two patients, aged 15-68 years, with an acute attack of OM underwent detailed clinical, biochemical, and neuroradiological evaluation.There were 62 patients with 86 attacks of OM. Whereas 48 patients had a single attack, 14 had 2 or more attacks, fulfilling the International Headache Society criteria for probable and definite OM, respectively. At presentation, isolated abducens, oculomotor, and trochlear nerve involvements were seen in 35 (56.5%), 21 (33.9%), and 5 (8.1%) patients, respectively. One patient had simultaneous involvement of 3rd and 6th nerves. Fifty-one (82.3%) patients exhibited an antecedent worsening in severity of migraine, before developing ophthalmoplegia during (59/95.2%) or within 24 hours (3/4.8%) of a severe migraine attack, respectively. Detailed biochemistry and cranial neuroimaging were normal. No case had any nerve enhancement. Use of steroids hastened recovery (P < .05).We conclude: (1) OM in adults is characterized by single attacks of ophthalmoplegia in a great majority of patients; and (2) 6th nerve involvement occurs commonly. Our results indicate that moving OM to the chapter on cranial neuralgias in the second edition of the International Headache Classification may be premature, since nerve palsy occurred during a severe migraine attack in all patients.