title: Painful ophthalmoplegia with normal cranial imaging.
abstract: BACKGROUND
  Painful ophthalmoplegia with normal cranial imaging is rare and confined to limited etiologies. In this study, we aimed to elucidate these causes by evaluating clinical presentations and treatment responses.
  
  
  METHODS
  Cases of painful ophthalmoplegia with normal cranial MRI at a single center between January 2001 and June 2011 were retrospectively reviewed. Diagnoses of painful ophthalmoplegia were made according to the recommendations of the International Headache Society.
  
  
  RESULTS
  Of the 58 painful ophthalmoplegia cases (53 patients), 26 (44.8%) were diagnosed as ocular diabetic neuropathy, 27 (46.6%) as benign Tolosa-Hunt syndrome (THS), and 5 (8.6%) as ophthalmoplegic migraine (OM). Patients with ocular diabetic neuropathy were significantly older (62.8 ± 7.8 years) than those with benign THS (56.3 ± 12.0 years) or OM (45.8 ± 23.0 years) (p < 0.05). Cranial nerve involvement was similar among groups. Pupil sparing was dominant in each group. Patients with benign THS and OM responded exquisitely to glucocorticoid treatment with resolved diplopia, whereas patients with ocular diabetic neuropathy didn't (p < 0.05). Patients with OM recovered more rapidly than the other groups did (p < 0.05). Overall, most patients (94.8%) recovered completely during the follow-up period.
  
  
  CONCLUSIONS
  Ocular diabetic neuropathy and benign THS accounted for most of the painful ophthalmoplegias in patients with normal cranial imaging. Patient outcomes were generally good.
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Hung
authors.forename: Kuo-Hsuan
authors.initials: KH
authors.lastname: Chang
authors.forename: Chun-Che
authors.initials: CC
authors.lastname: Chu
authors.forename: Ming-Feng
authors.initials: MF
authors.lastname: Liao
authors.forename: Hong-Shiu
authors.initials: HS
authors.lastname: Chang
authors.forename: Rong-Kuo
authors.initials: RK
authors.lastname: Lyu
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Wu
authors.forename: Yao-Liang
authors.initials: YL
authors.lastname: Chen
authors.forename: Chiou-Lian
authors.initials: CL
authors.lastname: Lai
authors.forename: Hsiao-Jung
authors.initials: HJ
authors.lastname: Tseng
authors.affiliation: Department of Neurology, Linkou Campus, Chang Gung Memorial Hospital and University College of Medicine, Gueishan Township, Taiwan. cgrols@adm.cgmh.org.tw.
authors.forename: Long-Sun
authors.initials: LS
authors.lastname: Ro
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D012189:Retrospective Studies; D020333:Tolosa-Hunt Syndrome / Q000175:diagnosis* / Q000628:therapy; D055815:Young Adult