MR findings in acute oculomotor neuropathy, leading to a diagnosis of Sjögren syndrome

Abstract

A 52-year-old woman presented with acute isolated right oculomotor palsy. Contrast enhanced MR showed abnormal enhancement of the right oculomotor nerve (figure), and a heterogenous and nodular appearance of the parotids with prominent fatty infiltration. On questioning, the patient reported recent feelings of dry mouth and eyes. Subsequent investigations revealed a raised erythrocyte sedimentation rate, positive anti-Ro antibody levels, Schirmer test, and minor salivary gland biopsy of the lower lip, confirming the diagnosis of primary Sjögren syndrome.1,2 The patient also underwent thorough investigations to exclude other etiologies, including a double stranded DNA for lupus and CSF examination, culture, and cytology; all these were negative. As patients with Sjögren syndrome rarely complain spontaneously of xerostomia and xeroophthalmia, 1 the incidental parotid MR findings in this patient led to the final diagnosis.

A case of Sjögren's syndrome presenting as trigeminal nerve palsy

“…An interesting feature of the presented case is that head MRI was credited with the diagnosis of trigeminal nerve disturbance associated with SS. To the best of our knowledge, there is one report of SS complicating PNS-SS found out on head MRIˆndings : a 52-year-old woman revealing oculomotor palsy, diagonosed with SS on the presence of nodular appearance of parotid gland and sicca symptoms revealed on medical interview 9) . SS is occasionally found by chance in patients with unnoticed sicca symptoms, based on the positiveness of anti-SS-A-antibody.…”

Neurologic Complications Associated with Sjögren’s Disease: Case Reports and Modern Pathogenic Dilemma

“…Diplopia is one of the most evident features related to alterations of cranial nerves, namely, oculomotor, trochlear, and abducens. Specific involvement of the III nerve in SS patients was described in 9 cases [ 4 , 11 , 18 , 38 , 57 , 64 , 69 , 71 ], of the VI in 7 cases [ 18 , 62 ], while only one patient with IV nerve alteration is present in the literature [ 47 ]. Moreover, several other reports illustrated cases of multiple neuritis including diplopia among the clinical features [ 7 , 13 , 17 , 36 , 41 , 42 , 48 , 50 , 60 , 82 ].…”