[Neurosarcoidosis: diagnosis and therapy]

Area of Science:

• Inflammatory and immune system disorders
• Neurology and neuroimmunology
• Systemic diseases

Context:

• Sarcoidosis affects 20-50 per 100,000 in West Germany.
• It stems from an abnormal immune response to an inhaled antigen.
• Granulomatous inflammation commonly impacts mediastinal lymph nodes, lungs, and potentially other organs.

Purpose:

• To outline the neurological manifestations of sarcoidosis.
• To detail diagnostic procedures for sarcoidosis.
• To present treatment strategies for neurosarcoidosis.

Summary:

• Neurologic involvement occurs in 5% of sarcoidosis cases, frequently presenting as cranial nerve palsies.
• Cerebral sarcoidosis includes granulomatous brain infiltration and meningeal inflammation.
• Myelopathies, peripheral neuropathies, and muscular involvement (often subclinical) are also discussed.
• Diagnostic tools include imaging (X-ray, CT, MRI), lab tests (ACE, Lysozyme), lavage, gallium scans, and biopsy.
• Treatment focuses on high-dose corticosteroids, with whole-brain irradiation for cerebral sarcoidosis and parenteral steroids for refractory peripheral neuropathy.

Impact:

• Clarifies diagnostic pathways for neurosarcoidosis.
• Provides an overview of therapeutic options for sarcoidosis affecting the nervous system.
• Highlights the importance of biopsy for confirming sarcoidosis diagnosis.