A case of neurosarcoidosis presenting with multiple cranial neuropathies

Sotaro Mori; Takuji Kurimoto; Kaori Ueda; Mari Sakamoto; Norio Chihara; Wataru Satake; Yuko Yamada-Nakanishi; Makoto Nakamura

doi:10.1016/j.ajoc.2020.100796

A case of neurosarcoidosis presenting with multiple cranial neuropathies

Am J Ophthalmol Case Rep. 2020 Jun 27:19:100796. doi: 10.1016/j.ajoc.2020.100796. eCollection 2020 Sep.

Authors

Sotaro Mori¹, Takuji Kurimoto¹, Kaori Ueda¹, Mari Sakamoto¹, Norio Chihara², Wataru Satake^{2

3}, Yuko Yamada-Nakanishi¹, Makoto Nakamura¹

Affiliations

¹ Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
² Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan.
³ Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Abstract

Purpose: We report a case of neurosarcoidosis that presented simultaneously with oculomotor nerve palsy, contralateral abducens nerve palsy, and paresthesia of both lower limbs.

Observations: A 69-year-old Japanese woman who suffered from repeated diplopia and lower-limb paresthesia was referred to our hospital. Ophthalmic findings included oculomotor nerve and contralateral abducens nerve palsies. No remarkable abnormalities were detected via enhanced brain magnetic resonance imaging (MRI), chest X-ray, and cerebrospinal fluid analysis. Chest computed tomography (CT) was performed to exclude neoplastic lesions; this revealed right hilar lymphadenopathy, and positron emission tomography MRI showed strong 18-F fluorodeoxyglucose uptake in the hilar lymph node. Biopsy of the lymph node showed non-caseating epithelioid granulomatous tissue, leading to a diagnosis of probable neurosarcoidosis. After the initiation of oral prednisolone treatment, the patient experienced complete remission without any recurrence.

Conclusions and importance: When examining a patient presenting with multiple cranial neuropathies of unknown cause, neurosarcoidosis should be considered as a differential diagnosis and chest CT should be performed even when the chest X-ray and angiotensin-converting enzyme appears normal.

Keywords: Abducens nerve palsy; Computerized tomography; Multiple cranial nerve palsies; Neurosarcoidosis; Oculomotor nerve palsy; Positron emission tomography.

Publication types

Case Reports