Ophthalmoplegic migraine: Reversible enhancement and thickening of the cisternal segment of the oculomotor nerve on contrast-enhanced MR images

BACKGROUND AND PURPOSE: Ophthalmoplegic migraine is a rare condition charac terized by the association of headaches and an oculomotor nerve palsy. We r eport six patients with typical clinical features of this disorder in whom enhancement of the cisternal segment of the oculomotor nerve developed duri ng the acute phase, followed by resolution of enhancement over several week s as the symptoms resolved. METHODS: Six patients, ages 3 to 27 years, underwent MR imaging during the acute phase of ophthalmoplegic migraine and at the time of recovery several weeks later. The MR studies, performed on a 1.5-T MR unit, included noncon trast and contrast-enhanced axial and coronal T1-weighted sequences, Sagitt al images were obtained in two patients, with and without contrast enhancem ent. RESULTS: Enhancement of the cisternal segment of the oculomotor nerve was s een in all patients at initial presentation. Contrast-enhanced studies also showed focal thickening at the exit of the nerve in the interpeduncular ci stern in five of six patients. No patient had enhancement of the cavernous sinus or adjacent dura, Enhancement was almost completely resolved on follo w-up studies 7 to 9 weeks later, CONCLUSION: Our findings confirm an intrinsic transient abnormality in the cisternal segment of the third nerve in patients with a typical clinical pr esentation of ophthalmoplegic migraine.