Disc edema, transient obscurations of vision, and a temporal fossa mass

A 56-year-old woman presented with a four-month history of transient obscurations of vision that progressed to constant visual loss. She had a nodular, lumpy-bumpy, cauliflower-like asymmetric edema of the nerve head, which suggested direct optic nerve head invasion with foreign tissue. Imaging of her intracranial contents revealed a well circumscribed gadolinium enhancing mass in the middle fossa. Histopathology of material obtained at craniotomy revealed noncaseating granulomata consistent with sarcoidosis. Central nervous system sarcoid may present either as an infiltrative granulomatous process, or one of discrete tumor mass, masquerading as a neoplasm. Neurologic symptoms and signs often herald the presence of systemic disease. Our illustrates that isolated sarcoid optic neuropathy may occur and be associated with neither intraocular inflammatory signs nor extensive disease elsewhere; indeed, it may be the first declaration of neurosarcoidosis.