[Abducens nerve palsy as the first manifestation of cavernous sinus sarcoidosis].

ABSTRACT

We report a 33-year-old man who presented with an acute onset of diplopia and orbitalgia. Neurological examination revealed right abducent nerve palsy. Brain MRI showed a gadolinium-enhancing mass lesion in the right cavernous sinus. Chest CT showed a small lymph node swelling in the subcarinal compartment. Serum angiotensin converting enzyme and lysozyme levels were within normal range. Biopsied lymph node in the left supraclavicular fossa showed non-caseating epitheloid granulomas, consistent with sarcoidosis. After oral administration of predonisolone, his right abducent nerve palsy ameliorated in a few days and completely disappeared by 6 weeks after treatment. Abducent nerve palsy can be the first clinical manifestation of cavernous sinus sarcoidosis.