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Six weeks later, she was hospitalised with diplopia secondary to a right lateral rectus palsy. Imaging showed abscess resolution but progressive bony remodelling and enhancement of the lateral extending into anterior skull base. Chest CT demonstrated upper lobe predominant pulmonary micronodules, and mastoid biopsy on revision surgery was notable for non-caseating granulomas. Further extensive work-up could not identify an alternative cause, and a presumptive diagnosis of neurosarcoidosis was made. The patient was initiated on intravenous steroids, experienced symptomatic improvement and was thereafter transitioned to oral steroid taper on discharge.<\/jats:p>","DOI":"10.1136\/bcr-2020-237676","type":"journal-article","created":{"date-parts":[[2020,11,2]],"date-time":"2020-11-02T16:05:14Z","timestamp":1604333114000},"page":"e237676","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Probable neurosarcoidosis presenting as acute on chronic otorrhoea: a difficult diagnosis"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0961-3327","authenticated-orcid":false,"given":"Shaan N","family":"Somani","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 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