Neurosarcoidosis: A Case Report

Area of Science:

• Neurology
• Immunology
• Pathology

Background:

• Sarcoidosis is a systemic granulomatous disease of unknown origin.
• Neurological involvement, termed neurosarcoidosis, is infrequent but significant.
• Cranial nerve palsies, particularly of the VII and VIII nerves, are key indicators of neurosarcoidosis.

Observation:

• A 54-year-old woman presented with constitutional symptoms, bilateral hearing loss, and later developed uveitis and facial palsy.
• Imaging revealed mediastinal lymphadenopathy, and PET scans showed hypercaptation.
• Cranial nerve involvement was confirmed by MRI showing inflammation of the cochlea, geniculate ganglion, and vestibulocochlear bundles.

Findings:

• Cerebrospinal fluid analysis indicated aseptic meningitis.
• Histopathological examination of mediastinal lymph nodes confirmed noncaseating granulomas, establishing the diagnosis of sarcoidosis.
• Treatment with high-dose steroids resulted in significant clinical improvement.

Implications:

• This case underscores the diagnostic complexities of neurosarcoidosis, often a diagnosis of exclusion.
• Early recognition and appropriate treatment are crucial for managing the unpredictable clinical course and prognosis of neurological sarcoidosis.
• Highlights the importance of considering neurosarcoidosis in patients with unexplained cranial neuropathies and systemic symptoms.