Neurosarcoidosis Presenting with Isolated Oculomotor Nerve Palsy

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Sarcoidosis is a multisystem granulomatous disease. Neurosarcoidosis occurs in approximately 5-15% of patients with systemic sarcoidosis. Since neurosarcoidosis can manifest in different fashions, diagnosis is sometimes difficult. Here, we present a case of 75-year-old woman with oculomotor neuropathy involving the pupil who had a history of systemic sarcoidosis. We excluded compressive causes of oculomotor neuropathy, such as aneurysm of the posterior communicating artery. Brain magnetic resonance imaging showed enhancement and thickening of the right oculomotor nerve, implying inflammation. Considering the potential for neurosarcoidosis in right oculomotor nerve, we administered high-dose corticosteroid therapy and the patient’s clinical symptom and neuroimaging finding improved. Isolated oculomotor nerve palsy in neurosarcoidosis is rare, and this is the first documented case of oculomotor nerve palsy involving the pupil in Korea. We suggest that it is important to recognize inflammatory causes of oculomotor nerve palsy, such as neurosarcoidosis, even in cases that involve the pupil. Key words: Sarcoidosis; Cranial nerve diseases; Oculomotor nerve diseases

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