Sudden Vision Loss Due to Optic Neuritis-An Uncommon Presentation of Neurosarcoidosis

Abstract

Sarcoidosis is a systemic, granulomatous disease of unknown etiology, most often manifested by mediastinal and hilar lymph node enlargement and parenchymal nodules in the lungs. However, it may involve any other organ. Neuro-sarcoidosis, a condition that affects up to 20% of sarcoidosis patients, can be found in any part of the central or peripheral nervous system and has important ophthalmic and neuro-ophthalmic manifestations. We present two patients with sudden vision loss due to neurosarcoidosis. In both cases, biopsy of the mediastinal lymph node showed non-caseating granulomas consistent with sarcoidosis. Treatment involved high doses of methylprednisolone intravenously, followed by topical dexamethasone eye drops in the first case and a systemic steroid treatment in the second, resulting in symptom relief. Those two cases demonstrate that sarcoidosis should be considered as a differential diagnosis in cases of optic neuritis.

Keywords: neuro-sarcoidosis; optic nerve neuritis; sarcoidosis.

Figure 1

Optical coherence tomography of the right eye showing edema of the optic disc.

Figure 2

Computed tomography of the chest, with contrast enhancement, coronal plane, mediastinal window (a), lung window (b). Enlarged mediastinal and hilar lymph nodes ((a)—white asterisk). Small nodules in the right lower lobe ((b)—white arrow).

Figure 3

T1-weighted images with fat saturation and with gadolinium contrast administration, sagittal plane. Contrast enhanced lesion in L4 vertebral body ((a)—white arrow) has reduced its size ((b)—white arrow). Similarly, the lesion in the spinous process L2 ((a)—white asterisk) has decreased in size ((b)—white asterisk).

Figure 4

T2-weighted images with fat saturation, axial plane—(a,b). Moderate edema of the intraconal fat secondary to optic neuritis ((a)—white asterisk). Resolution of edema on follow—up examination (b). T1-weighted image with gadolinium contrast administration, axial plane—(c,d). Heterogeneous optic nerve enhancement, more significant on the right side ((c)—white arrow). Marked partial regression of lesions on follow-up examination (d).