Neuro-ophthalmic sarcoidosis with extraocular-muscle involvement: neuroimaging

Barbosa, Lucas Yunes Cominatto; Scomparin, Luiza Maretti; Luccas, Rafael; Reis, Fabiano

doi:10.1055/s-0046-1827163

A 50-year-old woman presented with severe headache, diplopia, photophobia, and painful left ophthalmoplegia. The initial laboratory tests and cerebrospinal fluid analysis were unremarkable.¹ Neuroimaging revealed left temporal pachymeningeal thickening with homogeneous contrast enhancement and hypointensity on T2-weighted images, associated with enlargement of the left inferior rectus muscle. Chest computed tomography and positron-emission tomograpy–computed tomography scans demonstrated mediastinal and hilar lymphadenopathy with increased metabolic activity (Figures 1 2).² The histopathological analysis of a mediastinal lymph node showed non-necrotizing granulomas, confirming sarcoidosis. The corticosteroid therapy resulted in rapid clinical improvement and near-complete resolution of the imaging abnormalities on a follow-up magnetic resonance imaging scan (Figure 3).³,⁴

Figure 1
Axial contrast-enhanced head computed tomography (CT) scan showing focal pachymeningeal thickening and enhancement along the left temporal region (arrow in A). Coronal contrast-enhanced head CT demonstrating enlargement of the left inferior rectus and inferior oblique muscles (arrow in B). Coronal contrast-enhanced chest CT revealing left hilar and paratracheal lymphadenopathy (arrow in C).

Figure 2
Pretreatment axial brain magnetic resonance imaging (MRI) scan showing left temporal pachymeningeal thickening adjacent to the greater sphenoid wing, with low signal intensity on T2-weighted imaging (arrow in A). The corresponding postcontrast T1-weighted image demonstrates intense, homogeneous enhancement (arrow in B). Coronal brain MRI scan demonstrating thickening of the left inferior rectus and inferior oblique muscles, with high signal intensity on fluid-attenuated inversion recovery (FLAIR) imaging (arrows in C).

Figure 3
Follow-up brain MRI scan after treatment, demonstrating marked reduction of pachymeningeal (arrow in A) and left inferior rectus and inferior oblique muscle thickening and enhancement (arrow in B) on postcontrast T1-weighted imaging.

Funding

The authors declare that they did not receive funding from agencies in the public, private or non-profit sectors to conduct the present study.

Use of Artificial Intelligence

The authors declare that no artificial intelligence tools were used in the preparation of this manuscript.

Acknowledgements

The authors would like to thank the institutions that provided technical support for the development and implementation of the current study.

Data Availability Statement

No new data were generated or analyzed in this study.

References

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