Multiple cranial nerve enhancement on MRI in primary Sjögren's syndrome

A 77-year-old man showed bilateral abducens palsies and multiple cranial nerve enhancement on magnetic resonance images (MRI) and aseptic meningitis. He had xerophthalmia and xerostomia. Serum anti-SS-A and anti-SS-B antibodies were present. He had Sjögren's syndrome (SjS) and corticosteroid therapy ameliorated the symptoms. The cranial nerve enhancement and the cerebrospinal fluid findings were normalized. In patients with SjS, there have not been any reports of multiple areas of cranial nerve enhancement on MRI. We propose that in this case the aseptic meningitis and subsequent lymphocytic infiltration to the cranial nerves contributed to the multiple cranial neuropathy and multiple cranial nerve enhancement on MRI.