CASE REPORT Copyright © 2018 The Korean Society of Neurosonology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. pISSN 2635-425X eISSN 2635-4357 https://doi.org/10.31728/jnn.2018.00011 Sarcoidosis is a multiorgan granulomatous disease of unknown cause. It can involve various organs, such as the lungs, eyes, skin, and lymph nodes, and the nervous system. 1 Neurosarcoidosis presents in approximately 5-15% of patients with sarcoidosis, 2,3 and cranial neu- ropathy is the most common neurological complica- tion of sarcoidosis. 4 Facial nerve palsy is the most com- mon cranial neuropathy in neurosarcoidosis, 4 and optic nerve, vestibulocochlear nerve, and trigeminal nerve involvement have also been reported. 3 Neurosarcoidosis can manifest in different fashions and reaching a diagnosis may be complicated especially if it presents with rare clinical symptoms. 2,5 Here, we present a case of neurosarcoidosis that presented with isolated oculomotor nerve palsy. CASE REPORT A 75-year-old woman presented with right eye ptosis and diplopia, which had progressed over 2 months. In her past medical history, she had been admitted to the rheumatology department of our hospital in October 2016 due to a subcutaneous nodule around the left me- dial malleolus. She also had the respiratory symptom of dyspnea, and fatigue. On the chest X-ray, a pulmonary nodule was seen in right upper lobe. She underwent biopsy of the subcutaneous nodule during the admis- sion, which found a granuloma with multinucleated giant cells. Systemic sarcoidosis was suspected; there- fore, she was prescribed 2 mg methylprednisolone and 300 mg hydroxychloroquine daily. She also had a past medical history of hypertension, osteoporosis, idio- pathic thrombocytopenic purpura, and Ramsay-Hunt syndrome 6 years ago. She had left peripheral type facial palsy and hypesthesia in the left chin (V3 area) as sequelae of Ramsay-Hunt syndrome from 6 years ago. She did not have any history of diabetes mellitus, tuber- culosis, stroke, or head trauma. On neurological examination, the pupil of her right Sarcoidosis is a multisystem granulomatous disease. Neurosarcoidosis occurs in approximately 5-15% of patients with systemic sarcoidosis. Since neurosarcoid- osis can manifest in different fashions, diagnosis is sometimes difficult. Here, we present a case of 75-year-old woman with oculomotor neuropathy involving the pupil who had a history of systemic sarcoidosis. We excluded compressive causes of oculomotor neuropathy, such as aneurysm of the posterior communicating artery. Brain magnetic resonance imaging showed enhancement and thickening of the right oculomotor nerve, implying inflammation. Considering the potential for neurosarcoidosis in right oculomotor nerve, we administered high-dose cor- ticosteroid therapy and the patient’s clinical symptom and neuroimaging finding improved. Isolated oculomotor nerve palsy in neurosarcoidosis is rare, and this is the first documented case of oculomotor nerve palsy involving the pupil in Korea. We suggest that it is important to recognize inflammatory causes of oculomotor nerve palsy, such as neurosarcoidosis, even in cases that involve the pupil. J Neurosonol Neuroimag 2018;10(2):158-161 Key Words: Sarcoidosis; Cranial nerve diseases; Oculomotor nerve diseases Neurosarcoidosis Presenting with Isolated Oculomotor Nerve Palsy Hye-Rim Shin, Il-Yeon Choo, Eun Young Kim, Yong Woo Shin, Hyung-Min Kwon Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea Address for correspondence: Hyung-Min Kwon Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National Uni- versity College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea Tel: +82-2-870-2475 Fax: +82-2-831-2826 E-mail: hmkwon@snu.ac.kr Received: July 11, 2018 Revised: August 22, 2018 Accepted: August 28, 2018 JNN