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This abstract is assigned to session AOB and FRO E-Posters

Title	Multiple eye muscle palsy as a first sign of sarcoidosis?
Abstract Nr.	3016

Purpose	I will discuss the case of a 57 years old woman, who presented first in April 2014 with binocular horizontal diplopia due to complete right sixth nerve palsy, which resolved spontaneously after 6 months. January 2017, again she was seen with a sixth nerve palsy, this time on the left eye. May 2017 she presented with ptosis, a mydriatic fixed pupil, exotropia and motility disorders of the left eye, accounting for a complete palsy of the left third cranial nerve.
Methods	Apart from the eye motility disorder, the neurological and ocular exam was completely normal. Medical history consisted of migraine and hypercholesterolemia for which she was taking a statin. No other cardiovascular risk factors could be withheld.
Results	Blood tests and lumbar puncture appeared normal. The first MRI showed a small incidental lesion in the right lateral ventricle (DD astrocytoma, hamartoma, subependymoma), for which follow-up was indicated. Over the years, this lesion remained unchanged. MRI, performed in May 2017, did describe a new meningioma at the left cavernous sinus. However, this meningioma could not explain the former cranial nerve palsies. CT thorax showed enlarged mediastinal and hilar lymph nodes and various nodules in the lung parenchyma as in the upper abdomen, this image being suspicious of sarcoidosis. As a treatment of sarcoidosis, corticosteroids were started, with complete response within weeks.
Conclusion	In patients presenting with recidivating cranial nerve deficits, main differential diagnosis consists of MS, neuroborreliosis, increased intracranial pressure and neurosarcoidosis. Without other organ involvement, diagnosis of neurosarcoidosis is difficult and in ophthalmic disease, neurosarcoidosis most commonly presents with optic neuropathy.
Conflict of interest	No

Authors 1

Last name	DEBOUTTE
Initials	I
Department	Universiteit Antwerpen
City	Antwerpen