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Para-Prieto, L. Díaz-Cabanas, V.M. Asensio-Sánchez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Para-Prieto" "email" => array:1 [ 0 => "asensio@orangemail.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Díaz-Cabanas" ] 2 => array:2 [ "nombre" => "V.M." "apellidos" => "Asensio-Sánchez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Migraña oftalmopléjica: una urgencia oftalmológica real" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cephalea, specifically migraine, is nearly always identified through clinical history as this condition features a highly stereotyped anamnesis which allows a relatively easy diagnostic. However, migraine comprises a range of variants which require for diagnostic purposes an elaborate differential diagnostic exercise together with supplementary explorations such as NMR, eco-Doppler, etc. A bibliographic review confirms the scarcity of migraine varieties.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1,2</span></a> Accordingly ophthalmoplegic migraine (OM) is rare, with an incidence calculated in 0.7 cases per million inhabitants and year.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> It is crucial that ophthalmologists must be aware of its existence and know how to describe it because these patients generally visit the emergency department and are immediately referred to ophthalmology. Recently, we had a 35-year-old patient referred from the emergency department with left periocular pulsating pain to which 3 days later binocular diplopia was added due to palsy of the sixth left cranial pair, without other relevant findings. The patient did not refer relevant antecedents excepting the history of migraine without aura and 2 episodes similar to those which prompted her to visited the emergency department (left periocular pain with migraine characteristics and ocular palsy, in both cases resolved without treatment under one month).</p><p id="par0010" class="elsevierStylePara elsevierViewall">Three weeks after said visit, the pain was resolved only with analgesic treatment with persistence of a small limitation of the left eye external rectus. Analytics and neuroimaging studies (cranial NMR centered in orbit and cavernous sinus) did not exhibit alterations. OM expresses with cephalea episodes associated to palsy of one or more oculomotor pairs, in the absence of intracranial and/or orbitary morphological lesions. According to the <span class="elsevierStyleItalic">International Headache Society</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> the criteria for diagnosing OM are: (1) at least 2 episodes fulfilling item 2; (2) cephalea coinciding in time with palsy of one or more oculomotor pairs; and (3) parasellar lesion discarded by means of appropriate study. This type of migraine is more frequent between 4 and 10 years of age, and expresses in males. Ophthalmoplegia can appear after a few hours or even days after the headache. The remission of palsy takes between 3 and 4 weeks although in some cases it has endured 4 months. Said palsy affects the third cranial pair in 85% of cases and the sixth cranial pair in 12% percent of cases. No reports have been found for isolated fourth pair palsy. All 3 pairs are involved simultaneously in 12% of cases.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Even though ophthalmologists are very prudent when diagnosing OM, particularly if it is the first episode and the patient is “nontypical” (female, not a teenager), they must never forget the possibility of this clinic condition, particularly if an organic process has been discarded, thus avoiding unnecessary and very expensive tests as well as diminishing the anxiety of the patient and his or her family.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Para-Prieto M, Díaz-Cabanas L, Asensio-Sánchez VM. Migraña oftalmopléjica: una urgencia oftalmológica real. Arch Soc Esp Oftalmol. 2015;90:454.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Visual disturbances of migraine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.L. Hupp" 1 => "L.B. Kline" 2 => "J.J. Corber" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Surv Ophthalmol" "fecha" => "1989" "volumen" => "33" "paginaInicial" => "221" "paginaFinal" => "236" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2652358" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109714042491" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ophthalmoplegic migraine: from questions to answers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Ambrosetto" 1 => "F. Nicolini" 2 => "M. Zoli" 3 => "L. Cirillo" 4 => "P. Feraco" 5 => "A. Bacci" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Cephalalgia" "fecha" => "2014" "paginaInicial" => "1" "paginaFinal" => "6" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Headache Classification Committee of the International Headache Society (IHS), 3rd edition (beta version)" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "The International Classification of Headache Disorders" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0333102413485658" "Revista" => array:6 [ "tituloSerie" => "Cephalalgia" "fecha" => "2013" "volumen" => "33" "paginaInicial" => "629" "paginaFinal" => "808" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23771276" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009000000009/v1_201512030104/S2173579415001206/v1_201512030104/en/main.assets" "Apartado" => array:4 [ "identificador" => "8723" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009000000009/v1_201512030104/S2173579415001206/v1_201512030104/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579415001206?idApp=UINPBA00004N" ]
Journal Information
Vol. 90. Issue 9.
Pages 454 (September 2015)
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Vol. 90. Issue 9.
Pages 454 (September 2015)
Letter to the Editor
Ophthalmoplegic migraine: A real eye emergency
Migraña oftalmopléjica: una urgencia oftalmológica real
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506
M. Para-Prieto
, L. Díaz-Cabanas, V.M. Asensio-Sánchez
Corresponding author
Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, Spain
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