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Isolated third nerve palsy due to sarcoidosis
H Ueyama1, T Kumamoto, S Fukuda
1Third Department of Internal Medicine, Oita Medical University, Japan.
Abstract:
We present a 28-year-old man with isolated third nerve palsy as the initial manifestation of sarcoidosis. MRI demonstrated abnormal enhancement of the cisternal portion of the right third nerve. One month after steroid therapy, he showed almost complete recovery with resolution of the contrast enhancement on MRI. This patient illustrates the usefulness of enhanced MRI for detection of cranial nerve lesions of sarcoidosis.
Insights
Sarcoidosis can initially present as isolated third nerve palsy in rare cases. Enhanced MRI is crucial for detecting cranial nerve involvement in neurosarcoidosis, aiding diagnosis and treatment monitoring.
Area of Science:
- Neurology
- Ophthalmology
- Immunology
Background:
- Sarcoidosis is a multisystem inflammatory disease of unknown etiology.
- Cranial nerve involvement is a known manifestation of neurosarcoidosis.
- Isolated third nerve palsy is an uncommon initial presentation.
Observation:
- A 28-year-old male presented with isolated third nerve palsy.
- Magnetic Resonance Imaging (MRI) revealed abnormal enhancement of the cisternal portion of the right third cranial nerve.
- The patient received steroid therapy.
Findings:
- The patient experienced near-complete recovery of the third nerve palsy after one month of steroid treatment.
- Resolution of contrast enhancement in the affected cranial nerve was observed on follow-up MRI.
- This case highlights the diagnostic utility of enhanced MRI in neurosarcoidosis.
Implications:
- Enhanced MRI is valuable for identifying cranial nerve lesions in sarcoidosis.
- Early detection and treatment can lead to significant neurological recovery.
- This presentation underscores the diverse neurological manifestations of sarcoidosis.