Adult recurrent painful ophthalmoplegic neuropathy:one case report

CAO Xiao-jie; ZHANG Ming-jie; LU Zhi-jie; YIN Ze-gang; PENG Fang; LI Dan; HUANG Tao; ZHOU Xin-ping; FAN Jin

doi:10.3969/j.issn.1672-6731.2025.12.011

Abstract：A female patient, 18 years old, was admitted to the hospital on August 30, 2019, due to headache with vomiting for 8 days and ptosis with diplopia for 6 days. Eight days before admission (August 22, 2019), she developed right-sided headache after a cold, characterized by severe pulsating pain around the right eyebrow, which was unbearable, accompanied by one episode of projectile vomiting, with gastric contents as the vomitus. Laboratory tests at a local hospital showed a white blood cell count of 15.30×10^9/L [(3.50–9.50)×10^9/L], and chest CT showed no significant abnormalities. After treatment with cephalosporin antibiotics (specific regimen unknown), her headache improved. Six days ago, she experienced a recurrence of headache with progressive worsening, accompanied by right ptosis, diplopia, and exophthalmos, with occasional tearing. After intravenous treatment at a local hospital (specific regimen unknown), her headache slightly improved, but there was no improvement in right ptosis, diplopia, or exophthalmos. She was admitted to our hospital for further diagnosis and treatment, and was diagnosed with 'right oculomotor nerve palsy' upon outpatient examination. Since the onset of the disease, the patient had poor mental state and sleep, normal diet, no significant weight change, and no fever, impaired consciousness, speech difficulties, visual impairment, limb movement disorders, or incontinence. She had been healthy in the past. Her family reported that she had intermittent headaches since the age of 5, mainly on the right side, with no abnormalities found on head CT. She had experienced four episodes of severe headache lasting several hours or days, which were self-resolved or relieved by analgesics (specific regimen unknown). No special personal or family history.