Painful ophthalmoplegia associated with lymphoid hyperplasia of the nasopharynx

In the last ten years three patients presented with a subacute syndrome characterized by unilateral frontal headache, ipsilateral external ophthalmoplegia, Va or Vb hypoesthesia and peripheral facial palsy. In all of them, plain X-ray and/or CT revealed a nasopharyngeal mass. Orbital venography failed to fill the superior orbital vein ipsilateral to the ophthalmoplegia, suggesting a unilateral cavernous sinus pathology. Biopsy demonstrated lymphoid hyperplasia. Two patients recovered spontaneously, and in one, steroid treatment resulted in fast pain relief and progressing complete disappearance of the mass. In one patient a high titer of Epstein-Barr viral antibodies was detected.