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Case 23

Sarcoidosis

Optic neuropathy

This 40 year old man presented with painful eyes. He had also noted a dry cough. Examination revealed evidence of a left optic neuropathy. What abnormalities are shown and what is the likely diagnosis? (The MRI images are T1 coronal, post contrast).

Findings

On the CXR there is right lower zone consolidation, probably in the middle lobe. In addition there is the suggestion of bilateral hilar lymphadenopathy.

On the MRI no vascular lesions were seen on T2 weighted images of the brain. T2 STIR coronal images of the orbits demonstrated some increased signal due to oedema at the left orbital apex. Following contrast there is marked meningeal enhancement lateral to the left cavernous sinus, extending into the left orbit (illustrated). The left optic nerve also enhanced (not shown).

Diagnosis

Granulomatous meningeal disease of the left orbital apex, due to sarcoidosis.

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