Skip to main content

EHMTI-0321. Restricted diffusion in painful ophthalmoplegia

Introduction and aims

Superior ophthalmic vein (SOV) thrombosis is a rare disease entity characterized by rapidly progressive orbital symptoms, including periorbital edema, chemosis, proptosis and painful ophthalmoplegia. Since diagnostic delays represent a life-threatening danger, early recognition of disease is important for effective treatment and good prognosis. We report a patient with SOV thrombosis showing restricted diffusion within the vein on diffusion-weighted images (DWI) which may be helpful in the diagnosis of SOV thrombosis.

Methods and results

A 53-years-old man presented with headache and left eye swelling for 6 days. Neurological examination revealed proptosis, eyelid edema, and depression paresis in the left eye. Left pupil was dilated and sluggishly reacting to light. Orbit MRI showed diffuse enhancement in the left retro-orbital and periorbital area, and an intraluminal filling defect within the left SOV. DWI disclosed high signal intensity in the left SOV, confirmed on apparent diffusion coefficient (ADC) map by the low signal intensity in the corresponding region. These restricted diffusions were attributed to the presence of thrombus within the left SOV. Based on clinical symptoms and MRI findings, a diagnosis of SOV thrombosis caused by orbital cellulitis was made, and intravenous broad-spectrum antibiotics infusion was initiated. Over the next 7 days he showed a marked improvement of periorbital swelling, and limitation of the eye movement gradually improved.


DWI may provide a clue for the presence of intravascular clots according to the stage of thrombus formation which can help the diagnostic process in SOV thrombosis.

No conflict of interest.

Author information



Corresponding author

Correspondence to JH Choi.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Choi, J., Moon, I., Kim, S. et al. EHMTI-0321. Restricted diffusion in painful ophthalmoplegia. J Headache Pain 15, D8 (2014).

Download citation

  • Published:

  • DOI:


  • Apparent Diffusion Coefficient
  • Cellulitis
  • Restricted Diffusion
  • Diagnostic Delay
  • Periorbital Edema