Ophthalmoplegic migraine with bilateral internal ophthalmoplegia. A case report

Abstract

Purpose: To report a case of internal ophthalmoplegic migraine in a patient with persistent bilateral mydriasis and blurred vision. Case report: An 18-year-old female refers photophobia, phonophobia and an intense pulsating headache over the entire head. Her pupils did not react to light and showed loss of accommodation. Fundus evaluation showed papilledema in the right eye. She was referred to a neurologist for further evaluation. Results: Brain magnetic resonance imaging, magnetic resonance angiography and laboratory tests were reported as normal. An internal ophthalmoplegic migraine was diagnosed after excluding all possible differential diagnoses. Conclusions: Ophthalmoplegic migraine is considered a rare headache characterized by third, fourth or sixth cranial nerve palsy. Migraine episodes associated with mydriasis or known as internal ophthalmoplegic migraine are notably rare, and the diagnosis is one of exclusion. Dexamethasone and parecoxib resolved the migraine, but not the mydriasis.