To the Editor:
In his Hoyt Lecture on oculomotor ophthalmoplegic migraine (OM), Carlow (1) asked the question `Is it really migraine?` As an alternative, could occult vascular malformation within the third nerve be a mechanism for OM?
Oculomotor cavernous angioma has been reported in patients with third nerve palsy and enhancement of the nerve on cranial magnetic resonance imaging (MRI) (2,3). In addition, occult cavernous angiomas in the optic chiasm have been reported to produce acute episodes of visual loss and pain (“chiasmal apoplexy”) with spontaneous exacerbation and remission (4,5). Thus, I have two questions:
- In Dr. Carlow's review of the literature, did he encounter any ante-mortem or post-mortem examinations of the oculomotor nerve in a patient with OM?
- Has there ever been any evidence of hemorrhage using routine MRI or gradient echo imaging in any of these cases or would the lesion be too small to detect blood or an occult vascular malformation within the nerve?
Andrew G. Lee, MD
1. Carlow TJ. Oculomotor ophthalmoplegic migraine: is it really migraine? J Neuro-Ophthalmol 2002; 22:215–21.
2. Ogilvy CS, Pakzaban P, Lee JM. Oculomotor nerve cavernous angioma in a patient with Roberts syndrome. Surg Neurol 1993; 40:39–42.
3. Matias-Guiu X, Alejo M, Sole T, et al. Cavernous angiomas of the cranial nerves. Report of two cases. J Neurosurg 1990; 73:620–2.
4. Regli L, de Tribolet N, Regli F, Bogousslavsky J. Chiasmal apoplexy: haemorrhage from a cavernous malformation in the optic chiasm. J Neurol Neurosurg Psychiatr 1989; 52:1095–9.
5. Lavin PJ, McCrary JA, Roessmann U, Ellenberger C. Neurology 1984; 34:1007–11.