The authors report a case in a 10.5 year old girl admitted to the Centre hospitalier Guy-de-Chauliac, Montpellier, France, with a left painful ophthalmoplegia. She had a convulsion with fever and a left facial palsy at 6 years of age and since then complained of headaches. Four years later she had diplopia, left-sided ocular pain and ptosis. On admission, there was a complete III nerve and a VI nerve paralysis on the left. CT, EEG, evoked potentials, spinal tap, blood and immunologic tests were normal. Steroid therapy resulted in a rapid remission. The authors point out that the diagnosis is by exclusion of local and systemic disease and that the syndrome is difficult to differentiate from ophthalmoplegic migraine. 
COMMENT: Tolosa, in 1954, described this syndrome as a periarteritic lesion of the carotid syphon with the clinical features of a carotid infraclinoidal aneurysm. Hunt et al, in 1961, invoked an indolent inflammation of the cavernous sinus and described the beneficial response to steroids
Ophthalmoplegic migraine, in the differential diagnosis, has been reported in infants  and usually presents early in childhood. The III nerve palsy develops 24 hours or more after the onset of the migraine headache and coincides with the stage of vasodilation; presumably it is due to a localized pressure effect of the carotid artery.