Neurosarcoidosis presenting as isolated VI nerve palsy
- PDF / 3,569,639 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 26 Downloads / 219 Views
LETTER TO THE EDITOR
Neurosarcoidosis presenting as isolated VI nerve palsy Chad M. Kimmitt 1 & William D. M. Kennedy 1 & Golnaz Roshankar 2 & Lindsay M. Burrowes 3 & Carlos R. Camara-Lemarroy 4 Received: 31 May 2020 / Accepted: 19 October 2020 # Fondazione Società Italiana di Neurologia 2020
Dear Editor-in-Chief, Sarcoidosis is a multisystem inflammatory disorder characterized by the formation of non-caseating granulomas in various organ systems, mainly the lungs and the lymphatic system [1]. Neurosarcoidosis occurs in 5–10% of people with sarcoidosis, but due to its heterogeneous clinical presentation, and the low sensitivity of ancillary investigations, diagnosis is often difficult [1]. Multiple cranial neuropathies, aseptic meningitis, myelitis and other kinds of parenchymal involvement are the most frequent presentations [1].
Case report A 49-year-old man presented to the emergency room 48 h after developing sudden diplopia. On examination, visual acuity was 20/25 right eye (OD) and 20/20 left eye (OS). Intraocular pressures were normal. Anterior segment examination was normal. Fundoscopic examination was normal. Diplopia testing was positive in primary position and with left gaze. There was a left-sided − 2 abduction defect. The remainder of the neurologic exam was normal. He denied any other neurological or systemic symptoms. Past medical history included an episode of right-sided uveitis that resolved with topical anti-inflammatory treatment 2 years prior. At that time, his serum angiotensin-converting enzyme was mildly elevated * Carlos R. Camara-Lemarroy [email protected] 1
Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
2
Department of Medicine, University of Calgary, Calgary, Alberta, Canada
3
Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
4
Department of Clinical Neurosciences, MS Clinic, FMC, University of Calgary, 1403 29 Street NW, Calgary, Alberta T2N 2T9, Canada
to 62 IU (upper limit of normal 52 IU), but he did not have further imaging workup nor a definitive diagnosis. He remained asymptomatic until developing diplopia. Routine laboratory workup was normal, including glucose, anti-nuclear-antibodies, antiphospholipid antibodies, and acute phase reactants. A magnetic resonance image (MRI) of the brain was normal, with no leptomeningeal enhancement, and no abnormalities in the vasculature, brainstem, or cavernous sinus (Fig. 1b, c). Cerebrospinal fluid (CSF) testing was bland with normal pressure, protein, and cell count. An infectious panel was negative, including Herpes simplex I and II, Varicella Zoster Virus, and enterovirus. Paraneoplastic panels were negative. A computerized tomography (CT) scan of the chest revealed diffuse, bilateral mediastinal, and para-bronchial lymphadenopathy (Fig. 1a). Mycobacteria testing was negative, and biopsy of a mediastinal node revealed non-caseating granulomas consistent with sarcoidosis (Fig. 1e, f). We diagnosed our patient with sarcoidosis and, after considering other ca
Data Loading...
