Ophthalmoplegic migraine with persistent abducens nerve palsy

Area of Science:

• Neurology
• Ophthalmology
• Vascular Neurology

Background:

• Migraine is a common neurological disorder often accompanied by aura symptoms.
• Ocular motor nerve palsies, like abducens palsy, can rarely be associated with migraine.
• Persistent abducens palsy is an uncommon sequela of migraine.

Observation:

• A 27-year-old female presented with a history of recurrent left-sided migraines since childhood.
• At age 14, she developed transient left-sided diplopia (double vision) associated with migraine episodes.
• The diplopia progressively worsened, eventually becoming permanent, leading to the diagnosis of left abducens palsy.

Findings:

• Clinical examination confirmed a left abducens nerve palsy.
• Cerebral arteriography was performed to investigate potential vascular causes.
• The arteriography did not reveal any aneurysms or other vascular anomalies, suggesting a non-vascular etiology.

Implications:

• This case highlights a rare but significant long-term complication of migraine.
• The persistent abducens palsy in this patient, without identifiable vascular anomalies, suggests a possible migraine-associated mechanism.
• Further research is needed to understand the pathophysiology linking migraine to chronic cranial nerve palsies.