[A case of sarcoidosis with frequent recurrence of ophthalmoplegia]

A 72-year-old woman was admitted to our hospital with the complaint of recurrent ophthalmoplegia. During three months before her first consultation, she had experienced five episodes of ptosis and diplopia, which had lasted for about 1 month. No significant abnormality was shown with computed tomography (CT), magnetic resonance imaging (MRI) and MR-angiography on her brain. Cerebrospinal fluid was normal. Serum angiotensin converting enzyme (ACE) level was mildly elevated. The enlargement of hilar lymph nodes which showed non-caseating epitheloid granuloma suggestive of sarcoidosis was seen with chest X-ray and CT. A few days after the treatment of 60 mg of prednisolone every other day, ophthalmoplegia disappeared and no recurrence has been observed. Cranial nerve involvement tends to be seen commonly in neurosarcoidosis. By contrast, the nerves innervating the extraocular muscles are rarely involved. Although relapsing course of neurosarcoidosis is well known, no case with frequent recurrence of ophthalmoplegia during a few months has been reported.