Abstract
Recurrent painful ophthalmoplegic neuropathy (RPON) is a headache disorder classified
as a cranial neuropathy. It is characterized by episodes of unilateral headache followed
by ipsilateral ophthalmoplegia due to ocular cranial nerve palsy. Symptoms usually
subside spontaneously within weeks to months. RPON commonly occurs in childhood, though
it is overlooked at times as a possible differential diagnosis. The pathophysiology
of RPON is not entirely clear. Typical magnetic resonance imaging (MRI) findings in
children include nerve thickening and gadolinium enhancement. However, these findings
are not specific to this condition. Nerve thickening in RPON can resemble schwannomas,
thereby causing a diagnostic dilemma. Here, we present a 13-year-old boy with a history
of unilateral headaches associated with ipsilateral ptosis and diplopia. The first
MRI indicated thickening and gadolinium enhancement of the right oculomotor nerve,
which was interpreted as a schwannoma. However, his symptoms resolved after a few
weeks and the follow-up MRI showed resolution of nerve changes. This clinical presentation
was consistent with RPON. This case demonstrates the need for a careful follow-up
of RPON patients.
Keywords
recurrent painful ophthalmoplegic neuropathy - headache - schwannoma - case report
