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Published on: August 18, 2023
Painful ophthalmoplegia with normal cranial imaging
Chih-Hsien Hung, Kuo-Hsuan Chang, Chun-Che Chu
1Department of Neurology, Linkou Campus, Chang Gung Memorial Hospital and University College of Medicine, Gueishan Township, Taiwan. cgrols@adm.cgmh.org.tw.
Painful ophthalmoplegia with normal imaging is often caused by ocular diabetic neuropathy or Tolosa-Hunt syndrome (THS). While THS responds to steroids, ocular diabetic neuropathy does not, though most patients recover well.
Area of Science:
- Neuro-ophthalmology
- Neurology
- Internal Medicine
Background:
- Painful ophthalmoplegia with normal cranial imaging is a rare clinical presentation.
- Limited etiologies are known for this condition, necessitating further investigation.
Purpose of the Study:
- To identify the causes of painful ophthalmoplegia in patients with normal cranial MRI.
- To evaluate clinical characteristics and treatment responses for accurate diagnosis.
Main Methods:
- Retrospective review of 58 painful ophthalmoplegia cases with normal cranial MRI (January 2001-June 2011).
- Diagnosis adherence to International Headache Society criteria.
- Comparison of clinical presentations, cranial nerve involvement, and treatment outcomes across etiologies.
Main Results:
- Ocular diabetic neuropathy (44.8%) and benign Tolosa-Hunt syndrome (THS) (46.6%) were the most common diagnoses.
- Ophthalmoplegic migraine (OM) accounted for 8.6% of cases.
- Patients with THS and OM responded well to glucocorticoids, unlike those with ocular diabetic neuropathy.
- Most patients (94.8%) achieved complete recovery, with OM patients recovering fastest.
Conclusions:
- Ocular diabetic neuropathy and benign THS are the primary causes of painful ophthalmoplegia in patients with normal cranial imaging.
- Despite differing treatment responses, overall patient prognosis is favorable.
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