11/5/2023 0 Comments Migraine with aura not intractableLastly, compressive symptoms often resolve quickly once the offending lesion is relieved, which is in contrast to OM/RPON where resolution of deficits and symptoms is gradual. ![]() Furthermore, swelling in the walls of the intracavernous carotid artery would cause narrowing of the vessel however, carotid arteriograms during attacks of OM/RPON have not demonstrated this phenomenon, arguing against the theory of a compressive mechanism. In OM/RPON, however, these fibers may be spared in their review of 39 reported cases of OM/RPON, McMillian et al reported pupillary sparing in 23% of patients. However, arguments against this theory point out that in compression of the oculomotor nerve, the first nerve fibers to be affected are usually the parasympathetic fibers, which reside in the periphery of the nerve. ![]() Walsh and O’Doherty postulated in 1960 that dilatation or edema of the walls of the internal carotid artery (ICA) or posterior cerebral artery (PCA) during migraine headache might cause direct compression of the oculomotor nerves within the cavernous sinus. Potential etiologic mechanisms include compression, ischemia and demyelination. Most theories regarding the pathophysiology underlying OM/RPON are based on case reports and clinical and radiographic observations. While the exact pathophysiology has yet to be clarified, current belief is that OM/RPON is unlikely to be a subtype of migraine due to the delay in ophthalmoplegia after the onset of headache. PathophysiologyĬhanges in the condition’s name reflect the poorly understood pathophysiology of OM/RPON. In Nigerian populations, an association between OM/RPON and abnormal hemoglobin has been observed. In cases of reported OM/RPON, there is a high incidence of personal or family history of migraine headaches, suggesting that migraine may be a predisposing factor in the development of the condition. While migraine affects women more often than men, and prevalence peaks in middle-aged adults (2), OM/RPON is primarily a pediatric condition seen in children less than 10 years old and affects males more often than females. The demographics of OM/RPON differ from that of migraine. The most commonly affected cranial nerve is the oculomotor nerve, followed by the abducens nerve. Ophthalmoplegia may persist for weeks to months and is typically reversible. This rare condition manifests as episodes of ipsilateral headache followed by palsy of 1 or more ocular cranial nerves that begins immediately or up to 14 days after onset of headache. ![]() Ophthalmoplegic migraine (OM), more recently renamed recurrent ophthalmoplegic neuropathy (RPON) by the International Headache Society, is an uncommon and poorly understood condition with an incidence of 0.7 per million.
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