53 year old man with recurrent oculomotor palsies
- Slides: 5
53 year old man with recurrent oculomotor palsies Teaching Neuro. Images Neurology Resident and Fellow Section by Veronika Kana, Jens A. Petersen, Kristian Ikenberg, Ariane Chappaz, Christina Gerth-Kahlert, Philippe Appenzeller, and Michael Linnebank © 2016 American Academy of Neurology
Vignette • A 53 -year-old man presented with a recurrent left fourth nerve and acute left third nerve palsy. • Brain MRI showed leptomeningeal and oculomotor nerve contrast enhancement. • CSF examination indicated chronic lymphocytic meningitis with massively increased soluble IL-2 receptor and IL-6. • Extensive infectious disease workup remained unremarkable. • [18 F]-fluorodeoxyglucose (FDG)-PET/CT revealed active deep cervical lymph nodes containing non-caseating granulomas. • No pulmonary or other systemic manifestation was found. © 2016 American Academy of Neurology Kana V et al.
Imaging © 2016 American Academy of Neurology Kana V et al.
Imaging © 2016 American Academy of Neurology Kana V et al.
Recurrent oculomotor palsies due to neurosarcoidosis • Diagnostic findings were consistent with clinically isolated neurosarcoidosis. • Upon immunosuppressive treatment the oculomotor palsies rapidly remitted. • Neurosarcoidosis is a rare condition lacking specific biomarkers. • When suspected, FDG-PET/CT can guide diagnosis and prevent CNS biopsy. © 2016 American Academy of Neurology Kana V et al.
