Clinically isolated neurosarcoidosis: a recommended diagnostic path

Area of Science:

• Neurology
• Immunology
• Systemic Inflammatory Diseases

Background:

• Sarcoidosis is a multisystem inflammatory disease.
• Central nervous system involvement (neurosarcoidosis) presents with diverse, often nonspecific neurological symptoms.
• Clinically isolated neurosarcoidosis (CINS) can occur without overt systemic signs.

Purpose of the Study:

• To investigate the clinical characteristics and diagnostic patterns of neurosarcoidosis.
• To evaluate the frequency and impact of spinal cord involvement in neurosarcoidosis.
• To propose an optimized diagnostic pathway for neurosarcoidosis.

Main Methods:

• Retrospective analysis of 13 diagnosed neurosarcoidosis patients.
• Comparison of patients with and without clinically isolated neurosarcoidosis (CINS).
• Assessment of imaging (including spinal MRI) and cerebrospinal fluid findings.

Main Results:

• Spinal cord involvement was observed in 8 out of 13 patients, a higher prevalence than previously reported.
• Spinal cord affection correlated with older age at diagnosis and a less favorable therapeutic response.
• CINS patients showed no significant differences in age, imaging, or spinal fluid findings compared to other neurosarcoidosis patients.

Conclusions:

• Spinal cord involvement is a frequent manifestation of neurosarcoidosis.
• Early diagnosis and treatment of spinal cord sarcoidosis are crucial due to its association with poorer outcomes.
• Routine spinal magnetic resonance imaging (MRI) should be an integral part of the early diagnostic workup for suspected neurosarcoidosis.