Neuro‐ophthalmological findings in sarcoidosis

Abstract

ABSTRACT.Purpose: This review emphasizes the importance of neuro-ophthalmological signs and symptoms in sarcoidosis. The presence of ophthalmological and neuro-ophthalmological findings may lead to diagnosis of the disease and the initiation of adequate treatment. Material and Methods: Patients who had been diagnosed with neurosarcoidosis during the period 1990 À 2001 were identified from the departmental diagnostic index. The history, clinical, laboratory and imaging data of patients were analysed. Results: Fifteen patients were identified, four men and 11 women, with a mean age of 44.1 years (range 26-65 years). In six of the 15 (40%), neurological deficits were the initial symptoms. Nine (60%) had known sarcoidosis at the time of presentation. Ten patients (66%) had ophthalmological/neuro-ophthalmological symptoms and signs. Conclusion: Neuro-ophthalmological symptoms may develop early in neurosarcoidosis. If neuro-ophthalmological symptoms arise in patients with established biopsyproven sarcoidosis, the diagnosis is usually easy to make. However, a number of patients with neurosarcoidosis may present with neuro-ophthalmic symptoms before systemic involvement becomes obvious. In this situation the diagnosis is challenging, and the major goal is to establish the presence of systemic sarcoidosis.

Orbital inflammatory disease: a diagnostic and therapeutic challenge

“…6,17,22,33,47,61,62 In the absence of thyroid orbitopathy, orbital biopsy and histopathology may be required before onset of therapeutic intervention. Although corticosteroids are typically used in initial therapy, some idiopathic chronic forms of OID may be poorly responsive and require other therapeutic modalities including radiation therapy or immune modulation.…”

Brain MRI Depiction of Multiple Cranial Neuropathies in Neurosarcoidosis: A Case Report

“…The pathophysiological mechanism of the facial palsy is implicated in granulomatous mass, chronic meningitic reaction or secondary infl ammation in the parotid gland. Previous MRI studies suggested variable changes in patients with neurosarcoidosis [1][2][3]. With respect to cranial nerve palsy, Oki et al fi rst described a case that MRI showed enhanced mass in the distal internal auditory canal portion of the VII cranial nerve [5].…”

“…Of the cranial nerve involvement, the optic nerve was the most frequent lesion (35-38%) and the facial nerve was the second most common (11-19%) [1,2]. Otherwise, 4 or more kinds of cranial neuropathies were extremely rare in neurosarcoidosis [3,4]. The optic nerve is damaged by optic neuritis, intracranial hypertension or mass effect of intraorbital granuloma.…”

“…In previous reports with multiple neuropathies of the II, III, VII, IX and X cranial nerves, brain MRI was normal. However, it was not mentioned whether gadolinium-enhanced MRI was performed in those cases [3,4]. Gadolinium-enhanced brain MRI seems to display granulomatous massive lesions or chronic meningeal infl ammation in patients with neurosarcoidosis.…”

“…Cranial neuropathy is the common manifestation in neurosarcoidosis [1,2]. Multiple cranial neuropathies involving 4 or more kinds of the cranial nerves were reported in a few patients with neurosarcoidosis [3,4]. However, neuroradiological depiction remains unknown in those patients.…”