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Neurosarcoidosis presenting with a partial Claude syndrome
Hao Meng Yip1, Kirtana Vallabhaneni2, David Williams3
1Nephrology, North Middlesex University Hospital NHS Trust, London, UK meng.yip@nhs.net.
BMJ Case Reports
|November 22, 2019
Summary
Neurosarcoidosis rarely causes ischemic stroke. This case highlights a patient with sarcoidosis who experienced stroke symptoms, emphasizing diagnostic challenges and management considerations for this rare presentation.
Area of Science:
- Neurology
- Immunology
Background:
- Neurosarcoidosis commonly manifests as cranial neuropathy, polyneuropathy, myopathy, meningitis, or myelopathy.
- Ischemic stroke is an uncommon presentation of neurosarcoidosis in clinical reports.
Observation:
- A 52-year-old male with a history of cutaneous sarcoidosis presented with acute third nerve palsy, facial weakness, and ataxia.
- Brain MRI revealed midbrain signal changes indicative of an acute ischemic event, suggesting partial Claude syndrome.
- Cerebrospinal fluid analysis showed an elevated angiotensin-converting enzyme (ACE) level.
Findings:
- The case illustrates the diagnostic complexities in identifying neurosarcoidosis presenting as ischemic stroke.
- Elevated ACE levels in CSF can be a supportive marker for neurosarcoidosis.
Implications:
- This case expands the understanding of neurosarcoidosis presentations beyond typical neurological deficits.
- It underscores the importance of considering sarcoidosis in the differential diagnosis of ischemic stroke, especially in patients with a known history of the disease.
- Further research is needed to clarify the specific mechanisms and optimal management strategies for stroke in neurosarcoidosis.
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