Abstract
Neurosarcoidosis is a manifestation of sarcoidosis that affects the nervous system. It presents with a heterogeneous clinical picture. The diagnosis is established through clinical evaluation, imaging, and tissue biopsy in most cases. We discuss two cases that presented with symptoms suggestive of multiple sclerosis (MS) and stroke like features, but in fact yielded a diagnosis of neurosarcoidosis.
The first is a 54-year-old male with a background of diplopia and paraesthesia of his limbs, who subsequently had acute ataxia with gait imbalance, and new onset of vertical diplopia. Neuroimaging revealed multiple pontine, cerebellar, and temporal lobe acute infarcts, and leptomeningeal spinal enhancement. Cerebrospinal fluid analysis was consistent with diagnosis of neurosarcoidosis. The second is a 45-year-old female presenting with lower limb paraesthesia and shock like symptoms when she flexed her neck. She had no objective clinical deficit. Neuroimaging was performed and demonstrated thickening and FLAIR signal hyperintensity of the Corpus Callosum. Spinal imaging showed a large longitudinal intradural extramedullary lesion posteriorly at C2 and a smaller lesion anteriorly around the C1 region. Lymph node biopsy revealed numerous non-caseating epithelioid cell granulomas, with no evidence of mycobacterium suggestive of neurosarcoidosis.
Neurosarcoidosis should be considered in patients who present with symptoms suggestive of demyelinating or a stroke like episode(s). Early treatment is crucial for preventing disease-related morbidity and highlights the importance of clinician awareness of neurosarcoidosis and its diversity in presentation.
