Abstract
Objectives To describe a case of Sjogren’s syndrome presenting with weight loss secondary to a motor trigeminal neuropathy
Background Trigeminal neuropathy is well-recognised in Sjogren’s syndrome; typically a slowly progressive unilateral sensory neuropathy. Pure motor trigeminal neuropathies are rare.
Case Report An 85-year old woman with chronic kidney disease, hypertension, osteoarthritis, sleep apnoea and a pacemaker for sick sinus syndrome presented with two weeks of diplopia and 10kg weight loss over three months.
She was found to have a left trochlear nerve palsy and bilateral optic disc swelling. ESR was elevated upto 110. High dose steroids were prescribed for putative giant cell arteritis, however subsequent temporal artery biopsy was negative.
Neurology consultation revealed additional examination findings of normal corneal and facial sensation, with bilateral masseter and pterygoid weakness. The patient described being unable to eat, with difficulty chewing and sucking. She later developed appendicular sensory ataxia, and xerostomia.
MRI brain did not reveal any acute pathology. ANA was positive (homogenous and speckled pattern), with positive SCL-70, and Ro52 antibodies. The remainder of laboratory tests were unremarkable. Nerve conduction studies confirmed a sensory neuropathy.
The patient improved following intravenous immunoglobulins. She remains on intravenous immunoglobulins, mycophenolate and low dose prednisolone.
Conclusion We present a case of Sjogren’s syndrome presenting with bilateral motor trigeminal neuropathies, without sensory involvement.
