ophthalmoplegic migraine
Introduction
Introduction to ophthalmoplegia migraine Ophthalmoplegic migraine (OM), also known as ocular migraine migraine, is a syndrome characterized by recurrent episodes of extraocular muscle paralysis and migraine. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: nausea and vomiting headache
Cause
Ophthalmoplegia migraine cause
(1) Causes of the disease
The exact cause of ophthalmoplegia is still unclear. Since the application of cerebral angiography in 1930, the hypothesis caused by the compression of cavernous sinus aneurysm has been ruled out. Most people think that it is associated with vascular disorders, intravascular contraction, and cerebrovascular disease. Malformations, brain tumors, cavernous sinus specific or non-specific inflammation, paranasal sinusitis, sphenoid sinus cysts, etc., Alpens and Yaskin do pathological anatomy did not find this disease has organic lesions, but Nigerian eye muscle paralysis in Africa Hemoglobin levels are increased in patients with sexual migraine.
(two) pathogenesis
From the perspective of pathophysiology, the onset of migraine is the result of intracranial and extracranial vasoconstriction and dilation, which can be divided into four phases: pre-headache: intracranial vasospasm contraction causes ischemia of brain tissue; headache period: intracranial vasodilation Edema; late headache: headache peaks; late headache: headache gradually reduced and then moved to sleep, Siieteri et al reported that local tissue release of catecholamines at the beginning of migraine caused plasma serotonin to decrease causing pain in the brain to cause pain receptors, Walsh and Doherty believes that cerebral artery edema in the cavernous sinus oppresses the cranial nerves causing cranial nerve palsy (III, IV or VI), but cerebral angiography, CT examination does not see the above edema compression image, so the above theory cannot be confirmed, clinical application of blood vessels Dilators and corticosteroids are effective in treating and supporting the theory of vascular disorders.
Prevention
Ophthalmoplegia migraine prevention
Avoid alcohol and tobacco and avoid overwork.
Complication
Ophthalmoplegia migraine complications Complications, nausea and vomiting headache
Nausea and vomiting, headache, eye muscle paralysis, eye muscle spasm.
Symptom
Ocular muscle paralytic migraine symptoms Common symptoms Ophthalmoplegia paralyzed eyes can not be unilateral headache, eyelids, drooping head, jumping pain, numbness, nerve palsy, nausea
1. Classification of eye muscle paralytic migraine and symptomatic migraine 2 kinds:
(1) True ophthalmoplegia migraine: There is a typical unilateral or migraine headache, the attack time is several hours to several days, eye muscle paralysis occurs before or during the migraine attack, and eye muscle paralysis is often eye movement. Nerve paralysis, trochlear nerve and nerve palsy are rare, angiography and CT scan are normal, so cavernous sinus aneurysms and other organic diseases can be ruled out.
(2) Symptomatic ophthalmoplegia migraine: refers to a migraine caused by a space-occupying lesion in the cavernous sinus, especially an aneurysm.
2. Clinical features
(1) Migraine: Before the ophthalmoplegia, the headache is mostly on the top of the unilateral forehead, frontal or frontal forehead. The nature of the headache is paroxysmal pulsating pain or jumping pain, often accompanied by nausea. Vomiting.
(2) Ophthalmoplegia: Occurrence of eye muscle paralysis after migraine, often involving the third cranial nerve, manifested as complete oculomotor nerve paralysis symptoms, drooping eyelids, the outer side of the eyeball, the eyeball up, down, the internal movement is obvious Restricted, accompanied by dilated pupils; may also involve the VI brain, rarely invading the IV brain.
(3) When the migraine is relieved, the eye movement disorder is aggravated: if the IV and VI brain nerves are involved at the same time, the eyeball is fixed.
(4) headache, nausea, vomiting, ophthalmoplegia and other symptoms can last from several hours to 10 weeks, mostly for monocular onset, or both eyes or alternate disease.
(5) Ophthalmoplegia is temporary, but it can be repeated, the number of episodes is more than 2 to 4 times or more, and the interval between episodes does not change much. It can be several days or years. The higher the frequency of recurrence, the interval between them. The shorter.
(6) It is effective to take a vasodilator.
Examine
Examination of ophthalmoplegia migraine
Blood tests, blood glucose and other laboratory tests are mostly normal.
There were no abnormal findings in CT, MRI and carotid angiography.
Diagnosis
Diagnosis and diagnosis of ophthalmoplegia migraine
diagnosis
Ocular palsy migraine is rare in clinical practice. Diagnosis can be made based on migraine, ophthalmoplegia, recurrent episodes and clinical examination without obvious organic lesions.
Differential diagnosis
1. Diabetic ophthalmoplegia is characterized by ipsilateral eye pain and migraine within a few days of paralysis, but the pupil is not paralyzed, paralysis naturally recovers after 1 to 2 months, accompanied by increased blood glucose and other clinical manifestations of diabetes.
2. The characteristics of iliac arteritis are continuous knife-like pain in the head of the disease, local tenderness is obvious, the superficial temporal artery is red and swollen, and the hair is hard and strip-like, which can cause oculomotor nerve paralysis.
3. Painful ophthalmoplegia is a non-specific inflammation in the cavernous sinus and its vicinity, which can cause different degrees of paralysis and damage of cranial nerves III, IV, VI, accompanied by a side headache, clinical manifestations and eye muscles. Paralytic migraine is very similar, based on laboratory tests, CT, magnetic resonance imaging and carotid angiography can be identified.
