Recurrent Painful Ophthalmoplegic Neuropathy: A Diagnostic Challenge in the Pediatric Age

• Main Author: Camacho Sampaio, Margarida
• Publication Date: 2024
• Other Authors: Coimbra Queirós, Henrique, Palavra, Filipe, Pais, Rui Pedro, Paiva, Catarina, Costa, Carmen
• Format: Article
• Language: por
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: https://doi.org/10.46531/sinapse/CC/230059/2024
• topic: Child; Ophthalmoplegia/diagnosis; Ophthalmoplegic Migraine/ diagnosis; Ophthalmoplegic Migraine/ drug therapy; Criança; Oftalmoplegia/diagnóstico; Enxaqueca Oftalmoplégica/ diagnóstico; Enxaqueca Oftalmoplégica/ tratamento farmacológico

Recurrent painful ophthalmoplegic neuropathy (RPON) is a rare clinical entity, whose pathophysiology is not well understood. We present the case of a girl who, at 14 months of age, suddenly started right eyelid ptosis and incomplete paresis of the ipsilateral oculomotor nerve. Magnetic resonance imaging revealed a thickening of the emergence of that nerve. She was treated with corticosteroids and, over the years, presented multiple similar episodes, concluding with the diagnosis of RPON. The second case involves a 17-year-old girl with a history of episodic migraine and asymptomatic SARS-CoV-2 infection, also with right palpebral ptosis, with rapid progression to incomplete paresis of the ipsilateral oculomotor nerve. Ocular myasthenia gravis, a cranial neuralgia associated with COVID-19, and RPON were considered as hypotheses, with no recurrences to date. RPON recognition is difficult. This situation may contribute to its underestimation of prevalence, particularly in children.