ISOLATED NEUROSARCOIDOSIS

BackgroundInvolvement of the central nervous system is registered in a relatively small number of patients with Sarcoidosis. In this article we present a case that fulfills criteria for neurosarcoidosis (NS). In addition, we review the literature on NS with special attention to isolated cranial nerve involvement.Methods and ResultsA 45 year old diabetic female presented with isolated left sixth nerve palsy. Imaging showed enhancing lesion in pituitary gland and bilateral superior orbital fissure and cavernous sinus suggestive of granulomatous disorder. Endoscopic Endonasal TransSphenoidal biopsy of the sellar mass was performed. Histopathology showed Granulomatous Hypophysitis with features consistent with Neurosarcoidosis. A thorough work-up for systemic sarcoidosis was unyielding. Definitive Neurosarcoidosis was proven according to the criteria of Zajicek et al. Her diplopia resolved 2 weeks post surgery. She was not started on steroids or any immunosuppressant's. She was given only symptomatic treatment and is kept on a regular follow up for the past one year without any relapse. Conclusion. The diagnosis of NS is always a challenge. For this reason definitive diagnosis requires the exclusion of other causes of neuropathy. Multiple cranial neuropathies should always arouse suspicion of NS