Deboutte Isabel, Godts Daisy, Van Lint Michel
Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium.
Medical Science Department, University of Antwerp, Belgium.
GMS Ophthalmol Cases. 2023 Nov 7;13:Doc21. doi: 10.3205/oc000229. eCollection 2023.
To report a case of (neuro)sarcoidosis presenting solely with recurrent cranial nerve palsies in a 57-year-old Caucasian female.
Case report with clinical imaging.
A 57-year-old female first presented with a right sixth nerve palsy, which resolved spontaneously after 6 months. Three years later she was diagnosed with a sixth nerve palsy in the fellow eye followed by a complete palsy of the left third cranial nerve four months after. Medical history consisted of migraine and hypercholesterolemia. Further neurological and ophthalmic work-up was unrevealing at first. After repeated magnetic resonance imaging, an enhancing lesion in the left cavernous sinus was seen, which was initially diagnosed as a meningioma. However, imaging of the chest revealed an image of sarcoidosis, and the lesion and ophthalmoplegia of the left eye disappeared with systemic corticosteroid treatment.
Sarcoidosis is the ultimate imitator and the possibility of neurosarcoidosis must be taken into account when presented with unexplained ophthalmoplegia. Neurosarcoidosis has imaging properties very similar to other diseases such as a meningioma, and misdiagnosis occurs easily. Spontaneous recovery of ophthalmoplegia can rarely occur in neurosarcoidosis.
报告一例57岁白种女性仅表现为复发性颅神经麻痹的（神经）结节病病例。
采用临床影像学的病例报告。
一名57岁女性首次出现右侧第六颅神经麻痹，6个月后自行缓解。三年后，她被诊断出对侧眼第六颅神经麻痹，4个月后左侧第三颅神经完全麻痹。病史包括偏头痛和高胆固醇血症。起初，进一步的神经学和眼科检查未发现异常。在重复进行磁共振成像后，发现左侧海绵窦有一个强化病变，最初被诊断为脑膜瘤。然而，胸部影像学检查显示为结节病影像，全身使用皮质类固醇治疗后，左侧病变和眼肌麻痹消失。
结节病是最具迷惑性的疾病，当出现不明原因的眼肌麻痹时，必须考虑神经结节病的可能性。神经结节病的影像学表现与其他疾病（如脑膜瘤）非常相似，容易发生误诊。在神经结节病中，眼肌麻痹很少会自发恢复。
