Recurrent sixth nerve palsy and sjogren's syndrome - a case report and literature review

ABSTRACT

A 61 year old man presented with recurrent left lateral rectus palsy without any associated headache or other systemic symptoms. He was found to have an unexplained elevated ESR for the past three years. Subsequent investigations revealed positive anti-nuclear [ANA] and anti-Ro [SSA] antibodies. There was evidence of hypergammaglobulinaemia without any monoclonal band or Bence Jones protein in urine. The MRI brain, CT orbit and X ray chest were normal. A Schirmer's test was strongly positive despite the absence of symptoms of dryness of eyes. Clinical picture was consistent with primary Sjogren's syndrome