Third cranial nerve palsy? Look for a sicca syndrome

Area of Science:

• Neurology
• Immunology
• Ophthalmology

Background:

• Sjogren's syndrome (SS) is a systemic autoimmune disease characterized by exocrine gland dysfunction.
• Neurological complications are common in Sjogren's syndrome, affecting various parts of the nervous system.
• Oculomotor nerve (third cranial nerve) palsy is a rare but significant neurological manifestation.

Observation:

• A 79-year-old woman presented with sudden onset of right incomplete third cranial nerve palsy.
• Extensive investigations were conducted to determine the underlying cause of the palsy.
• The patient's symptoms were attributed to primary Sjogren's syndrome.

Findings:

• Diagnosis of primary Sjogren's syndrome was established in the patient.
• The patient received treatment with intravenous immunoglobulin (IVIg) and corticosteroids.
• Significant recovery from the third cranial nerve palsy was observed following treatment.

Implications:

• Sjogren's syndrome should be considered in the differential diagnosis of apparently idiopathic third cranial nerve palsies.
• Early diagnosis and appropriate treatment of Sjogren's syndrome can lead to reversible neurological deficits.
• This case highlights the importance of recognizing neurological manifestations of Sjogren's syndrome for timely intervention and improved patient outcomes.