Pupil-involving Oculomotor Palsy as the Initial and Only Manifestation of Neurosarcoidosis

Neurosarcoidosis has variable clinical features, making diagnosis difficult. About 5-15% of patients with systemic sarcoidosis will later develop neurosarcoidosis. However, only 1% of patients have CNS involvement from sarcoidosis at the time of initial presentation. Palsies of the facial and optic nerves are the most common CNS findings. To our knowledge, there are only 2 cases in the literature of oculomotor palsy as the first sign of sarcoidosis, and the present case is the only where oculomotor palsy is the sole clinical finding.