A Contrast Enhanced Lesion of the III Nerve on MR of a Patient With Ophthalmoplegic Migraine as Evidence for a Tolosa-Hunt Syndrome


Andreas Straube, M.D., Department of Neurology, Klinikum Grosshadern, Marchioninis-trasse 15, 8000 Muinch 70, F.R.G.



A 23-year-old female with a six year history of migraine without aura twice developed a nearly complete internal and external III nerve paresis ipsilateral to her headache, two days after the onset of migraineous headache. An MR scan performed one week after the second episode showed a contrast enhanced lesion of the prepontine III nerve, where it enters the cavernous sinus on the left side. The headache, as well as the paresis ameliorated spontaneously. We suggest this is a further well documented case of “ophthalmoplegic migraine” which might reflect Tolosa-Hunt syndrome.