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Title: A rare cause of reversible unilateral third nerve palsy
Authors: Lui, N.-L.
Thumboo, J. 
See, S.-J.
Keywords: Cranial nerve disease
Sjogren's syndrome
Issue Date: 2008
Citation: Lui, N.-L., Thumboo, J., See, S.-J. (2008). A rare cause of reversible unilateral third nerve palsy. Journal of the Neurological Sciences 275 (1-2) : 188-190. ScholarBank@NUS Repository.
Abstract: Case report: A 59-year-old Chinese male presented in January 2007 with acute left retro-orbital headache, diplopia and left partial ptosis. Isolated left third nerve palsy was diagnosed. Imaging studies and cerebral angiography excluded a posterior communicating artery aneurysm. Anti-nuclear (titre 1/800, speckled pattern), anti-PR3, anti-Ro and anti-La antibodies were present. Sjogren's syndrome (SS) was considered in view of positive anti-Ro and La antibodies, and was confirmed with focal lymphocytic infiltrates on labial salivary gland biopsy and a positive Schirmer's test (6 mm of tear flow over 5 min). Immunosuppressive therapy was started 2 months after his initial presentation and within 2 weeks, the patient experienced an almost complete recovery of both ptosis and diplopia. He has been on tapering doses of prednisolone since and his condition remains stable. Conclusion: This patient has cranial neuropathy secondary to Sjogren's syndrome. The rapid reversibility of the oculomotor nerve palsy with immunosuppression suggests lymphocytic infiltration or autoantibodies as the cause rather than a vasculitic process, which would have led to irreversible or slowly, partially reversible ischaemic damage. © 2008 Elsevier B.V. All rights reserved.
Source Title: Journal of the Neurological Sciences
ISSN: 0022510X
DOI: 10.1016/j.jns.2008.08.001
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