Neurosarcoidosis Flare with Multifocal Restricted Diffusion: Stroke, Inflammation, or Both?

Area of Science:

• Neurology
• Immunology
• Radiology

Background:

• Sarcoidosis is a multisystem granulomatous disease with diverse clinical manifestations.
• Neurological involvement in sarcoidosis is common, presenting with various symptoms.
• Leptomeningeal enhancement is a recognized neuroimaging finding in neurosarcoidosis.

Observation:

• Reports of stroke-like symptoms or magnetic resonance imaging (MRI) evidence of ischemia in sarcoidosis are infrequent.
• This report details a unique case of a patient with sarcoidosis exhibiting both leptomeningeal enhancement and multifocal restricted diffusion on MRI.

Findings:

• The patient presented with clinical and radiological features suggestive of central nervous system involvement.
• Multifocal restricted diffusion on MRI, indicative of acute ischemia, was observed concurrently with leptomeningeal enhancement.
• These findings represent a rare presentation of neurosarcoidosis.

Implications:

• This case expands the spectrum of neuroimaging findings associated with sarcoidosis.
• It underscores the importance of considering sarcoidosis in the differential diagnosis of stroke-like presentations with leptomeningeal enhancement.
• Further research may elucidate the mechanisms underlying ischemic changes in neurosarcoidosis.