Un caso di neurinoma del III nervo cranico in paziente cefalgico noto

Acquired third nerve palsies are rare in children but are often associated with significant underlying pathologies. This article describes a paediatric case of isolated third nerve palsy due to a schwannoma. A 10-year-old boy with a history of migraine presented with severe ophthalmic migraine and complaints of oblique diplopia. Clinical examination revealed horizontal diplopia in both primary and secondary gaze positions, with normal fundoscopic findings and a visual acuity of 10/10 bilaterally. Neurological assessment, including a non-contrast head CT scan, showed no acute or expansive intracranial processes. However, contrast MRI revealed the presence of a schwannoma affecting the right third cranial nerve. The treatment plan included analgesics and non-steroidal anti-inflammatory drugs, with no indication to neurosurgical treatment. Given the patient’s diplopia, prismatic lenses were prescribed, which led to a significant improvement also of his migraine. Additionally, a thorough genetic workup was conducted to investigate potential schwannomatosis.