Five new cases and 30 others from the literature were characterized by the clinical triad of progressive external ophthalmoplegia, atypical pigmentary degeneration of the retina, and heart block. The syndrome is sporactic, not hereditary, and begins by the age of 20 years. In many cases there is other evidence of widespread neurological disorder, implicating specific areas: cerebellum; auditory and vestibular systems; skeletal muscle; and, less often, intellectual function or corticospinal tracts. Short stature and delayed sexual maturation are also frequent. The CSF protein content is almost always greater than 100 mgidl. Spongioform encephalopathy was found in 4 postmortem examinations. In all cases so examined, muscle mitochondria were abnormal.The constancy of these manifestations suggests that the disorder is a true entity, not an artificial subclass of the large group of disorders associated with ophthalmoplegia. Several characteristics suggest that the disorder of neuronal and muscle metabolism is induced by persistent viral infection.

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Sequential computerized tomography (CT) was performed on a patient with seizures and an organic mental syndrome. Cerebral sarcoidosis was subsequently diagnosed on the basis of noncaseating granulomas in three organ systems. Cranial nerve palsies, hypothalamic dysfunction, and widespread disease were absent. An unusual neuroradiologic sequence of events indicated focal and asymmetric hydrocephalus, mass effect, ependymitis, diffuse breakdown of the blood-brain barrier, and periventricular white matter destruction. These findings have not been previously described together in a patient with sarcoid. With the advent of noninvasive CT, it is possible to perform serial investigations of encephalopathies of obscure origin. Findings similar to those in the present case should prompt a thorough search for subclinical systemic involvement by sarcoid.