Neurosarcoidosis Revealed by Isolated Abducens Nerve Palsy (P07.154)

Abstract

Objective: To report a rare case of neurosarcoidosis revealed by isolated abducens nerve palsy. Background Isolated abducens nerve palsy has been rarely reported in neurosacroidosis. Design/Methods: Case report. Results: A 23 year old man with no past medical history developed left painless left eye proptosis and double vision. Three month later, he was hospitalized because of new onset of seizure. His neurological examination demonstrated left abducens palsy. His blood work up was normal including normal ACE level. His CSF examination showed normal protein level, 9 white cells without any malignant cells. EEG was normal. Head MRI with and without contrast demonstrated revealed diffuse thickening and enhancement of the dura involving left cavernous sinus, mild mass-effect upon left temporal lobe, soft tissue enhancement extending anteriorly through foramen rotundum into the left orbital apex. His dural biopsy revealed extensive chronic inflammation containing non-necrotizing granulomas, consistent with sarcoidosis. The patient was started on high dose of methylprednisolone for 5 days. (1g each day), followed by a tapering prednisone for 2 months. The patient progressively improved. He became asymptomatic after one week of treatment and did not have any recurrence of seizure after 8 months of follow up. Conclusions: Although rare, neurosarcoidosis should be considered in the differential diagnosis of cavernous sinus syndromes with isolated sixth nerve palsy. Disclosure: Dr. Rajasingham has nothing to disclose. Dr. Souayah has received personal compensation for activities with Walgreens as a consultant. Dr. Souayah has received research support from Talecris.