Question

Following cranial nerve is most commonly involved in patients with sarcoidosis:

• A. II Cranial nerve.
• B. III Cranial nerve.
• C. VII Cranial nerve.
• D. IX Cranial nerve.

Hint:

Recall Heerfordt syndrome: parotid swelling, uveitis, fever, and facial nerve palsy in sarcoidosis.

Answer 1

The Correct Option is C

Sarcoidosis can involve the nervous system, a pattern called neurosarcoidosis, and cranial nerve palsy is one of its most recognizable signs. This question asks which cranial nerve gets hit most often.

1. II Cranial nerve: the optic nerve can be affected, showing up as optic neuritis, but this happens far less often than facial nerve disease.
2. III Cranial nerve: oculomotor nerve palsy is described in sarcoidosis but stays uncommon compared to facial nerve involvement.
3. VII Cranial nerve: the facial nerve is the one most typically affected. It can cause weakness on one or both sides of the face, and bilateral facial palsy in particular should make a clinician think of sarcoidosis. It is also the palsy seen in Heerfordt syndrome, along with parotid swelling, uveitis, and fever.
4. IX Cranial nerve: glossopharyngeal nerve involvement in sarcoidosis is rare and not the classic pattern tested here.

Since facial nerve palsy is the hallmark cranial neuropathy of sarcoidosis, the correct choice is the VII cranial nerve.

Let's summarize:

• Facial nerve (VII) palsy, sometimes bilateral, is the classic cranial nerve finding in sarcoidosis.
• Optic and oculomotor nerve involvement occur but are much less common.

So the answer is the VII cranial nerve.