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Left Sided Ptosis in Patient with Medical History of Migraine and Allergy: The Case Report of Probable Ophthalmoplegic Migraine

Krzysztof Jerzy Nicpoń, Joanna Jaroszuk-Nicpoń, Barbara Książkiewicz and Krzysztof Wawrzyniec Nicpoń

Background: Ophtalmoplegic migraine is a very sophisticated condition characterized by ophtalmoplegia or ophtalmoparesis accompanied by ipsilateral headache. Previously considered as a type of migraine with cranial nerves palsy and finally has being interpreted as a recurrent painful ophthalmoplegic neuropathy.
Case: We present the case of a female patient with medical history of migraine that developed left sided ptosis. We suppose that there may have been an allergic mechanism involved. We have not found any other reasonable explanation for the cause of the symptoms. Moreover, the patient exhibited acute hives accompanied by Quincke’s edema. We suspect that it could be the expression of the cross reaction between allergens of orange and gadolinium based magnetic resonance contrast. After the treatment with steroids the symptoms diminished. Full range of diagnostic procedures has been applied to exclude secondary causes of the symptoms.
Conclusion: Clinicians are obliged to perform the wide differential diagnosis of the headache accompanied by oculomotor dysfunction. We suggest that in the cases of no objective cause of the symptoms, we should take into account ophtalmoplegic migraine. That might lead to more targeted diagnostic procedures and better therapy.