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Tinnitus as a presenting symptom of neurosarcoidosis with ocular involvement
  1. Isaac G Freedman1 and
  2. Anita A Kohli1,2
  1. 1Department of Ophthalmology and Visual Sciences, Yale School of Medicine, New Haven, Connecticut, USA
  2. 2Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Anita A Kohli; anita.kohli{at}


A 48-year-old woman with untreated hypothyroidism initially presented with tinnitus and hearing loss, followed by blurred vision and eye pain months later. Ophthalmic evaluation revealed no optic disc oedema. Visual field defects in both eyes suggested retrobulbar optic neuropathy. MRI of the brain and orbits demonstrated enhancement of both optic nerve sheaths and diffuse pachymeningeal enhancement. Audiologic evaluation revealed hearing loss in both ears, and frequent square wave jerks were seen on videonystagmography. Fine needle aspiration from one pulmonary lymph node showed non-necrotising granulomatous inflammation, confirming the diagnosis of neurosarcoidosis. The visual fields improved significantly on prednisone, and she is maintained on prednisone, infliximab and methotrexate. Though common, multiple cranial neuropathies in neurosarcoidosis are poorly represented in the literature. Clinicians should be aware of the symptoms that may herald a diagnosis of neurosarcoidosis, so that treatment may be implemented sooner, and further cranial neuropathies may be prevented.

  • ophthalmology
  • neuroopthalmology
  • cranial nerves
  • immunology
  • neuroimaging

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  • Contributors AAK clinically treated the patient and obtained informed consent for the publication of this report. IGF and AAK both gathered the patient data, performed research and drafted and finalised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.