PRESUMED BILATERAL OCCIPITAL NEUROSARCOIDOSIS - A CASE-REPORT

A 37-year-old man with a history of sarcoidosis, hypertension, asthma, depression and prior intravenous drug use presented with complaints o f difficulty in finding his way around the house, headache, and blurre d vision in both eyes. The symptoms had been increasing in severity ov er the prior several months. Physical examination showed normal visual acuity, pupil reactions, and fundi but severe, circumferential constr iction of the visual fields bilaterally. The visual fields enlarged ap propriately on increasing the distance from the patient to the tangent screen. Neuroimaging revealed bilateral, occipital meningeal involvem ent and parenchymal lesions consistent with sarcoidosis. Treatment wit h oral corticosteroids produced a mild subjective improvement in the p atient's symptoms and stabilized the visual fields, without improving them. This case represents an unusual presentation of presumed neurosa rcoidosis involving the visual pathways at the level of the occipital lobes.