Optic Neuropathy and Macular Ischemia Associated with Neurosarcoidosis: A Case Report

Tanyıldız, Burak; Doğan, Gizem; Kaymak, Nilüfer Zorlutuna; Tezcan, Mehmet Engin; Cömert, Sevda Şener; Arsan, Aysu Karatay

doi:10.4274/tjo.49799

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…The disfunction of the nerve can be caused by different pathological processes, such as granulomatous infiltration of the nuclei of the specific nerves, the increase of the intracranial pressure or by meningitis (damaging the subarachnoid part of the nerve). Sorting by the frequency of affliction, the unilateral affliction of facial nerve is the most common presentation, followed by n. opticus with scotoma [4,5].…”

Section: When To Suspect Neurosarcoidosis?mentioning

confidence: 99%

Neurosarcoidosis - an ever-present clinical challenge

et al. 2021

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Sarcoidosis afflicts the central nervous system more frequently than previously believed. Neurological symptoms are present in roughly a half of patients, and depend of the location in central nervous system. The probability of spontaneous regression is significantly less when compared to other forms of sarcoidosis, which means that the proper diagnosis and treatment is paramount. Even when properly treated, functional defects are not uncommon. Majority of these patients require immunomodulating drugs and continuous follow-up. New immunomodulating drugs, especially biological agents, have shown to be significantly more effective, with fewer side effects, and are important when corticosteroids could not be applied. Less invasive methods, such as cerebrospinal analysis, help greatly in the diagnostics procedure, and require further research and improvement

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Section: When To Suspect Neurosarcoidosis?mentioning

confidence: 99%

Neurosarcoidosis - an ever-present clinical challenge

et al. 2021

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Sarcoidosis

Henderson¹

2021

Controversies in Neuro-Ophthalmic Management

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Neuro-Ophthalmic Manifestations of Sarcoidosis

Henderson¹,

Tian²,

Carey³

2020

Journal of Neuro-Ophthalmology

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Background: Sarcoidosis is an idiopathic, multisystem, inflammatory disease that has central nervous system involvement in 5%-15% of cases. The presentation of neurosarcoidosis is highly variable, and the MRI findings often mimic the appearance of other central nervous system diseases. Therefore, the diagnosis can be challenging. About one-third of neurosarcoidosis cases have neuro-ophthalmic manifestations and, thus, may be evaluated by a neuroophthalmologist early in the disease course. Methods: We performed a retrospective review of 22 cases of biopsy-proven sarcoidosis with neuro-ophthalmic manifestations, seen at the Wilmer Eye Institute from January 2013 to September 2019, in which we described the demographic information, clinical presentations, neuroimaging findings, and diagnostic evaluations. Results: Twenty-two patients were included. Fifteen patients identified as black and 7 as white. Fifteen were women, and 7 men. Mean age at sarcoidosis diagnosis was 45.9 years (range 26-66). Neuro-ophthalmic findings included optic neuropathy in 11 (50%); proptosis/orbital inflammation in 5 (23%); abducens palsy in 5 (23%); trochlear palsy, trigeminal distribution numbness, and bitemporal hemianopia in 2 each (9%); and oculomotor palsy, facial palsy, optic perineuritis, dorsal midbrain syndrome, central vestibular nystagmus, and papilledema in 1 each (5%). Eight (36%) had a pre-existing diagnosis of sarcoidosis; however, in 14 (64%), the neuro-ophthalmic presentation led to the sarcoidosis diagnosis. Patients with a pre-existing sarcoidosis diagnosis were younger than those without this diagnosis (38.5 vs 50.1 years, P = 0.035). Brain MRI was abnormal in all but 1 case (95%). In patients without a pre-existing sarcoidosis diagnosis, all 7 tested for angiotensin converting enzyme (ACE) had normal values, and 75% of the 12 who had computed tomography (CT) chest had findings suggestive of sarcoidosis (86% of black patients vs 50% of white patients). Conclusions: Patients with neurosarcoidosis may present initially with a neuro-ophthalmic manifestation, and this presentation may be more common in older patients. MRI usually is abnormal, although findings may be nonspecific.Serum testing for ACE is not helpful. Normal CT chest does not rule out underlying sarcoidosis, particularly in white patients.

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Optic Neuropathy and Macular Ischemia Associated with Neurosarcoidosis: A Case Report

Cited by 3 publications

References 17 publications

Neurosarcoidosis - an ever-present clinical challenge

Neurosarcoidosis - an ever-present clinical challenge

Sarcoidosis

Neuro-Ophthalmic Manifestations of Sarcoidosis

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